Provider Demographics
NPI:1205587649
Name:WEBB, SHANDA (NA)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15778 ROBERTS LOOP
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72732-8822
Mailing Address - Country:US
Mailing Address - Phone:430-280-9451
Mailing Address - Fax:
Practice Address - Street 1:2710 S RIFE MEDICAL LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:430-280-9451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care