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General NPI Number Information
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NPI Number | 1447857552
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Entity Type | Individual
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Provider Name | NICOLE GENEVIEVE SHADWICK CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 101 CIVIC CENTER LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5607
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Country | US
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Telephone | 928-855-8185
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Fax | 928-453-0453
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE CB 8054
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 800-862-9980
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Fax | 314-362-1185
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95002021
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11022686
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2022021771
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1026890
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License Number State | TX
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