Individual
DANIELLE SHADRACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1640 E KEARNEY ST, SPRINGFIELD, MO 65803-4106
(417) 863-9190
Mailing address
1640 E KEARNEY ST, SPRINGFIELD, MO 65803-4106
(417) 863-9190
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2020029486
MO
Other
Enumeration date
12/02/2019
Last updated
12/04/2020
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