Provider Demographics
NPI:1366996910
Name:BURNINGHAM, JANA LOUISE (FNP-C)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:LOUISE
Last Name:BURNINGHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 N 350 E
Mailing Address - Street 2:
Mailing Address - City:GENOLA
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8187
Mailing Address - Country:US
Mailing Address - Phone:801-369-4537
Mailing Address - Fax:
Practice Address - Street 1:852 EXPRESSWAY LN
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1300
Practice Address - Country:US
Practice Address - Phone:801-794-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT310758-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily