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General NPI Number Information
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NPI Number | 1649726290
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Entity Type | Individual
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Provider Name | SHANDELON GARNER RN
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 2240 WINROW RD
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City | FORT HUACHUCA
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State | AZ
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Zip | 85613-5080
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Country | US
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Telephone | 520-533-5126
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Fax |
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Provider Business Mailing Address
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Address Line | 127 CARLSON LOOP
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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 | 318-218-5688
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-117468
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 186149
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License Number State | AZ
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