Healthcare Provider Details

I. General information

NPI: 1134831233
Provider Name (Legal Business Name): SHANNON CUDDAHEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SHAFFER ST
KALAMAZOO MI
49048-1604
US

IV. Provider business mailing address

1910 SHAFFER ST
KALAMAZOO MI
49048-1604
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-9820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704344352
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: