Shawntae Marie Gagnon, CNM, WHNP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

11772267-4405 Issued in UT

Practice address

1660 W Antelope Dr Ste 205
Layton, UT 84041-1165

Phone

(801) 917-6104

NPI assigned

Apr 10, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vitality Generation & Midwifery LLC

  • Midwife
  • Ogden, UT
  • NPI 1336669100
  NPD (past)
• Vitality Generation & Midwifery, LLC

  • Birthing Clinic/Center
  • Ogden, UT
  • NPI 1750858403
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1124871942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 VALERIA DR",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840413314",
            "telephone_number": "435-730-5329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 W ANTELOPE DR STE 205",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840411165",
            "telephone_number": "801-917-6104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "564 Valeria Dr",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840413314",
            "country_code": "US",
            "telephone_number": "435-730-5329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "SHAWNTAE",
        "middle_name": "MARIE",
        "credential": "CNM, WHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "UT",
            "license": "11772267-4402",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "UT",
            "license": "11772267-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Fullmer
• Carli Gable
• Alvin Adams Gabrielsen Jr., M.D.
• Mary Gaede
• Shauna Gagner, MD
• Chelsie Gall
• Tristan Gallegos
• Coleen Galliher I
• Amanda Galt
• Liliana Galvan

• Women's Health Nurse Practitioner in Layton, UT
• Providers in Layton, UT by specialty
• Women's Health Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.