Individual
MS. NICOLE GENEVIEVE SHADWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
101 CIVIC CENTER LN, LAKE HAVASU CITY, AZ 86403-5607
(928) 855-8185
(928) 453-0453
Mailing address
660 S EUCLID AVE, CB 8054, SAINT LOUIS, MO 63110-1010
(800) 862-9980
(314) 362-1185
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1026890
TX
367500000X
Certified Registered Nurse Anesthetist
2022021771
MO
367500000X
Certified Registered Nurse Anesthetist
95002021
CA
367500000X
Certified Registered Nurse Anesthetist
APRN11022686
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910112970
—
MO
Enumeration date
10/02/2020
Last updated
09/08/2025
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