Individual
SHAUNA L MCBRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
168 N 100 E, ST GEORGE, UT 84770-2893
(435) 986-2565
(435) 986-2577
Mailing address
168 N 100 E, ST GEORGE, UT 84770-2893
(435) 986-2565
(435) 986-2577
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
58509011206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000057177
MEDICARE B
—
05
—
352163112003
—
UT
01
—
352163112017
MEDICAID PCN
—
01
—
461819
MEDICARE UGS
UT
Enumeration date
01/17/2006
Last updated
03/19/2014
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