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General NPI Number Information
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NPI Number | 1477429611
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Entity Type | Individual
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Provider Name | SHANDINA MANYCOWS
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Gender | Female
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | RIO VISTA ESTATES LOT #24
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City | SANDERS
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State | AZ
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Zip | 86512
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Country | US
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Telephone | 928-688-3903
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Fax | 928-688-4471
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Provider Business Mailing Address
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Address Line | 947 CERRITO DR
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City | GALLUP
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State | NM
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Zip | 87301-5421
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Country | US
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Telephone | 928-688-3903
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Fax | 928-688-4471
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN-80451
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 343048
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License Number State | AZ
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