Individual
MISTY SHADDUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
455 N MESA DR STE 8E, MESA, AZ 85201-5996
(937) 768-2544
(877) 991-6652
Mailing address
70 S VAL VISTA DR # A3-618, GILBERT, AZ 85296-1374
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
32549101
NY
164W00000X
Licensed Practical Nurse
Primary
PN301121
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/05/2024
Last updated
01/05/2024
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