Individual
MANARDIE FRANCIS SHIMATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNAP, CRNA
Contact information
Practice address
3773 CHERRY HILLS CIR, SYRACUSE, UT 84075-8402
(801) 786-9233
Mailing address
3773 CHERRY HILLS CIR, SYRACUSE, UT 84075-8402
(801) 786-9233
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
164348
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
277586-4406
UT
367500000X
Certified Registered Nurse Anesthetist
AP30006270
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190246100
DEPT OF LABOR
UT
01
—
219498
ALTIUS
UT
05
—
49408844
—
CO
01
—
68295
PEHP
UT
01
—
TPRA07902
MOLINA
UT
Enumeration date
08/10/2006
Last updated
10/03/2018
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