Individual
SHANNON LACEY STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1 MEADOWS PKWY, VIDALIA, GA 30474-8759
(912) 538-5537
Mailing address
PO BOX 1303, VIDALIA, GA 30475-1303
(912) 538-5537
(912) 538-5228
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN188967
GA
Other
Enumeration date
02/02/2012
Last updated
08/27/2015
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