Individual
SAMANTHA M SHANKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1101 W UNIVERSITY DR, ROCHESTER, MI 48307-1863
(248) 652-5354
(248) 652-5861
Mailing address
1101 W UNIVERSITY DR, ROCHESTER, MI 48307-1863
(248) 652-5354
(248) 652-5861
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704239106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11904296
CAQH
—
01
—
F36455226
CHMC MEDICARE PTAN
—
Enumeration date
01/30/2007
Last updated
04/11/2017
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