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General NPI Number Information
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NPI Number | 1588052864
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Entity Type | Individual
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Provider Name | SHANNON CREGEUR DARKET NP
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Gender | Female
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 01/08/2015
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Provider Practice Location Address
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Address Line | 2240 WINROW AVE USA MEDDAC, RWBAHC
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City | FORT HUACHUCA
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State | AZ
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Zip | 85613
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Country | US
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Telephone | 734-834-4096
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Fax |
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Provider Business Mailing Address
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Address Line | 2839 GREENBRIER RD
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-5601
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Country | US
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Telephone | 734-834-4096
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704291576
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License Number State | MI
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