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Individual

SHANE CARLLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
829 CHEIF EDDIE HOFFMAN HWY, BETHEL, AK 99559
(907) 549-6809
(907) 543-7110
Mailing address
PO BOX 528, BETHEL, AK 99559-0528
(907) 543-6809
(907) 543-7101

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
27765
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1020986
AK
Enumeration date
12/12/2013
Last updated
12/12/2013
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