Provider Demographics
NPI:1659153443
Name:DRAKE, SHRI JERRENE (PHD, LAC)
Entity Type:Individual
Prefix:
First Name:SHRI
Middle Name:JERRENE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 N TUCSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1133
Mailing Address - Country:US
Mailing Address - Phone:520-286-3055
Mailing Address - Fax:
Practice Address - Street 1:3545 N TUCSON BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1133
Practice Address - Country:US
Practice Address - Phone:520-286-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000743171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist