Doctor Name: | SHANNON RANAE STAFFORD |
NPI Number: | 1063542884 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP |
License Number: | F-091658 |
Business Practice Address: | 1604 2nd Ave Council Bluffs, IA - 515013801 |
Business Phone Number: | 7123226650 |
Business Fax Number: | 7123287985 |
Mailing Address: | 2512 Thallas St, COUNCIL BLUFFS |
State: | IA |
Postal Code: | 515038600 |
Phone Number: | 7123259977 |
Fax Number: | |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | F-091658 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |