Individual
JENNIFER ANN SHADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 E BEVERLY AVE STE B, KINGMAN, AZ 86409-3564
(928) 263-1335
(928) 272-0173
Mailing address
1740 E BEVERLY AVE STE B, KINGMAN, AZ 86409-3564
(928) 263-1335
(928) 272-0173
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
RN164008
AZ
Other
Enumeration date
12/02/2019
Last updated
03/16/2024
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