Provider Demographics
NPI:1891478582
Name:PETERS, SHIANNA (MS, RN)
Entity Type:Individual
Prefix:
First Name:SHIANNA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7696
Mailing Address - Country:US
Mailing Address - Phone:406-871-0291
Mailing Address - Fax:
Practice Address - Street 1:389 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7696
Practice Address - Country:US
Practice Address - Phone:406-871-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-70321163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support