Healthcare Provider Details

I. General information

NPI: 1043612617
Provider Name (Legal Business Name): SHANA SPEER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S PLUMER
TUCSON AZ
85719
US

IV. Provider business mailing address

102 N PLUMER AVE
TUCSON AZ
85719-5906
US

V. Phone/Fax

Practice location:
  • Phone: 520-990-1008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number183553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: