Individual
SHAINA BRENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2851 N EARL DR, WASILLA, AK 99654-9352
(409) 200-0194
Mailing address
2851 N EARL DR, WASILLA, AK 99654-9352
(409) 200-0194
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
7091
AK
Other
Enumeration date
06/03/2014
Last updated
06/03/2014
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