Provider Demographics
NPI:1164750923
Name:DAMSCHRODER, SHELLY BETHANN (RN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:BETHANN
Last Name:DAMSCHRODER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3101 CLEARWATER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7180
Mailing Address - Country:US
Mailing Address - Phone:928-237-9014
Mailing Address - Fax:928-237-9063
Practice Address - Street 1:3101 CLEARWATER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7180
Practice Address - Country:US
Practice Address - Phone:928-237-9014
Practice Address - Fax:928-237-9063
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-05
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP7289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily