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Individual
SHANE SAMUEL
Active
Individual
SHANE SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
308310
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Enumeration date
03/28/2024
Last updated
07/12/2024
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