Individual
SHANNON RANAE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1604 2ND AVE, COUNCIL BLUFFS, IA 51501-3801
(712) 322-6650
(712) 328-7985
Mailing address
2512 THALLAS ST, COUNCIL BLUFFS, IA 51503-8600
(712) 325-9977
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
F-091658
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0131656
—
IA
Enumeration date
03/07/2007
Last updated
07/08/2007
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