Provider Demographics
NPI:1255796876
Name:SHOAF, COLLEEN CONSTANCE (CD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CONSTANCE
Last Name:SHOAF
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 KIMBLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-6354
Mailing Address - Country:US
Mailing Address - Phone:775-397-2224
Mailing Address - Fax:509-757-3987
Practice Address - Street 1:323 KIMBLE DR
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-6354
Practice Address - Country:US
Practice Address - Phone:775-397-2224
Practice Address - Fax:509-757-3987
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049-82374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula