Provider Demographics
NPI:1326292129
Name:SHADDEN, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:SHADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 LOUIS HENNA BLVD
Mailing Address - Street 2:# 1014
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7331
Mailing Address - Country:US
Mailing Address - Phone:512-771-0250
Mailing Address - Fax:512-436-8660
Practice Address - Street 1:670 LOUIS HENNA BLVD
Practice Address - Street 2:# 1014
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7331
Practice Address - Country:US
Practice Address - Phone:512-771-0250
Practice Address - Fax:512-436-8660
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232737163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse