Basic Information
| Provider Information | |||||||||
| NPI: | 1790874238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHINKLE | ||||||||
| FirstName: | DEBRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 S 500 E | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841021959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015876336 | ||||||||
| FaxNumber: | 8017158228 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 MILLPOND STE 100 | ||||||||
| Address2: | |||||||||
| City: | STANSBURY PK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840749760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358433000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 198054-1205 | UT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.