Individual
SHANE MOZINGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2841 N 920 E, NORTH LOGAN, UT 84341-5806
(435) 512-1066
Mailing address
2841 N 920 E, NORTH LOGAN, UT 84341-5806
(435) 512-1066
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10646550-3102
UT
Other
Enumeration date
08/19/2020
Last updated
12/14/2020
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