Individual
MRS. COLLEEN M SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 E BANNOCK ST, BOISE, ID 83712-6207
(208) 342-7400
(208) 342-1879
Mailing address
300 E BANNOCK ST, BOISE, ID 83712-6207
(208) 342-7400
(208) 342-1879
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-41423
ID
363LF0000X
Family Nurse Practitioner
NP-1127A
ID
363LF0000X
Family Nurse Practitioner
Primary
NP1127A
ID
Other
Enumeration date
08/31/2011
Last updated
10/04/2018
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