Provider Demographics
NPI:1205140951
Name:DAWE, SHANTEL D (DNP PMHNP)
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:D
Last Name:DAWE
Suffix:
Gender:F
Credentials:DNP PMHNP
Other - Prefix:
Other - First Name:SHANTEL
Other - Middle Name:D
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 W ELECTION RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 W ELECTION RD STE 140
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7761
Practice Address - Country:US
Practice Address - Phone:385-382-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6858779-3102163WP0809X
UT6858779-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult