Individual
SHAWNTAYA BERTHARENE PRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12033 AGENCY RD, PARKER, AZ 85344-7718
(760) 922-1750
Mailing address
12033 AGENCY ROAD, PARKER INDIAN HEALTH CENTER, PARKER, AZ 85344
(760) 922-1750
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/03/2008
Last updated
09/03/2008
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