Individual
SHAUNA MUCKLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2304 CENTRAL AVE, KEARNEY, NE 68847-5349
(308) 237-3044
(308) 237-3051
Mailing address
2304 CENTRAL AVE, KEARNEY, NE 68847-5349
(308) 237-3044
(308) 237-3051
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
001009538704
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025378300
—
NE
Enumeration date
05/10/2011
Last updated
05/10/2011
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