Provider Demographics
NPI:1457822728
Name:SHACKELFORD, ASHLEY ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANNE
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 N 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-3206
Mailing Address - Country:US
Mailing Address - Phone:602-336-2990
Mailing Address - Fax:602-336-2271
Practice Address - Street 1:3801 W MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2133
Practice Address - Country:US
Practice Address - Phone:602-336-2646
Practice Address - Fax:602-242-2791
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011035509164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse