Individual
MRS. NICOLE WARNER SHAHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2545 E INTREPID AVE, MESA, AZ 85204-7028
(208) 716-2350
Mailing address
2545 E INTREPID AVE, MESA, AZ 85204-7028
(208) 716-2350
(480) 378-2279
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
6826
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477078764
—
AZ
Enumeration date
08/07/2017
Last updated
09/17/2024
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