Individual
SHAKA SHAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN
Contact information
Practice address
275 NE 10TH AVE, OAK HARBOR, WA 98277-5903
(256) 454-3260
Mailing address
2420 WENTWORTH DR, MONTGOMERY, AL 36106-3239
(256) 454-3260
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1-116694
AL
Other
Enumeration date
08/07/2024
Last updated
08/07/2024
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