Individual
SHANNON M KOVALCIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4840 E INDIAN SCHOOL RD STE 101, PHOENIX, AZ 85018-5500
(602) 224-6174
Mailing address
24431 N 38TH TER, GLENDALE, AZ 85310-3360
(623) 399-8717
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP2427
AZ
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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