Individual
LISA SHAMBLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4510 PENNSYLVANIA AVE, CHARLESTON, WV 25302-4835
(304) 965-9081
(304) 471-2488
Mailing address
11517 ELK RIVER RD N, CLENDENIN, WV 25045-6206
(304) 389-9400
(304) 471-2488
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
30302
WV
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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