Individual
SHELLY STAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5121 S COTTONWOOD ST, MURRAY, UT 84107
(801) 507-7673
Mailing address
5121 S COTTONWOOD ST, MURRAY, UT 84107-5701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
82980553102
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
942854057
—
UT
Enumeration date
07/30/2018
Last updated
08/24/2018
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