Individual
SHALISE FERNANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1330 W AUTO DR, TEMPE, AZ 85284-1017
(480) 553-7153
Mailing address
1330 W AUTO DR, TEMPE, AZ 85284-1017
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841543345
—
AZ
Enumeration date
05/18/2022
Last updated
05/18/2022
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