Individual provider · Type 1 NPI
Misty Shadduck, LPN
Licensed Practical Nurse · Mesa, AZ
NPI number
1043080476
Active
Practice location
455 N Mesa Dr Ste 8E
Mesa, AZ 85201-5996
Fax (877) 991-6652
Mailing address
70 S Val Vista Dr # A3-618
Gilbert, AZ 85296-1374
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Licensed Practical Nurse | 164W00000X | 32549101 (NY) |
| Student in an Organized Health Care Education/Training Program | 390200000X | None listed |
| Licensed Practical Nurse Primary | 164W00000X | PN301121 (PA) |
Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
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About NPI 1043080476
Misty Shadduck, LPN's National Provider Identifier is 1043080476, issued on Jan 5, 2024. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Mesa, AZ. The record was last updated on Jan 5, 2024.