Healthcare Provider Details

I. General information

NPI: 1598590465
Provider Name (Legal Business Name): SHELBY CASPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

20951 E REUNION RD
RED ROCK AZ
85145-5086
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5600
  • Fax:
Mailing address:
  • Phone: 801-837-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number10378824-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: