Provider Demographics
NPI:1386195766
Name:WALDROP, SHONDA (RN)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:
Last Name:WALDROP
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:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:LOVING
Mailing Address - State:NM
Mailing Address - Zip Code:88256-0098
Mailing Address - Country:US
Mailing Address - Phone:575-745-2077
Mailing Address - Fax:
Practice Address - Street 1:602 S 6TH
Practice Address - Street 2:
Practice Address - City:LOVING
Practice Address - State:NM
Practice Address - Zip Code:88256
Practice Address - Country:US
Practice Address - Phone:575-745-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-76814163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool