Individual
DR. BRENNA MAE SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
520 S EAGLE RD STE 3102, MERIDIAN, ID 83642-6352
(208) 381-1615
(208) 381-5141
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01067626A
IN
207P00000X
Emergency Medicine Physician
23824
NV
207P00000X
Emergency Medicine Physician
A133488
CA
207P00000X
Emergency Medicine Physician
M15461
ID
207P00000X
Emergency Medicine Physician
MD19340
HI
207PH0002X
Hospice and Palliative Medicine (Emergency Medicine) Physician
Primary
M-15461
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/28/2008
Last updated
08/06/2024
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