Individual
SHANE EVERETT STOCKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3495 W KAMRAN RIDGE CV, SOUTH JORDAN, UT 84095-8499
(304) 982-9556
Mailing address
3495 W KAMRAN RIDGE CV, SOUTH JORDAN, UT 84095-8499
(304) 982-9556
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3086781-4406
UT
367500000X
Certified Registered Nurse Anesthetist
64006
WV
Other
Enumeration date
10/03/2006
Last updated
09/10/2013
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