Healthcare Provider Details

I. General information

NPI: 1952698144
Provider Name (Legal Business Name): SHANITA WEBB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

PSC 80 BOX 16268
APO AP
96367-0065
US

V. Phone/Fax

Practice location:
  • Phone: 318-630-4817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHI VAVRA
Title or Position: MATERNAL CHILD FLIGHT COMMANDER
Credential: WHNP
Phone: 318-630-4817