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General NPI Number Information
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NPI Number | 1154955201
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Entity Type | Individual
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Provider Name | SHAYNA CHRISTINE ADKISON
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Gender | Female
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 452 W FINNIE FLAT RD STE M
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City | CAMP VERDE
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State | AZ
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Zip | 86322-7298
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Country | US
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Telephone | 702-370-6268
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Fax |
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Provider Business Mailing Address
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Address Line | 2961 S ASPEN WAY
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City | CAMP VERDE
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State | AZ
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Zip | 86322-6501
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Country | US
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Telephone | 702-370-6268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 25265
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License Number State | AZ
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