Provider Demographics
NPI:1003867821
Name:SHIBLER, STEPHANIE CAMILLE (RN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:CAMILLE
Last Name:SHIBLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 89 BOX 328
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-9704
Mailing Address - Country:US
Mailing Address - Phone:907-733-9265
Mailing Address - Fax:907-733-1735
Practice Address - Street 1:34300 S TALKEETNA SPUR RD
Practice Address - Street 2:
Practice Address - City:TALKEETNA
Practice Address - State:AK
Practice Address - Zip Code:99676
Practice Address - Country:US
Practice Address - Phone:907-733-9265
Practice Address - Fax:907-733-1735
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM7332Medicaid