Individual
MRS. SHALESE MARIE KILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
250 W 300 N, ROOSEVELT, UT 84066-2336
(435) 722-4691
Mailing address
PO BOX 1854, ROOSEVELT, UT 84066-1854
(435) 724-3545
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
9012696-3102
UT
363LF0000X
Family Nurse Practitioner
Primary
9012696-4405
UT
Other
Enumeration date
03/10/2020
Last updated
03/21/2020
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