Provider Demographics
NPI:1700430717
Name:SHANK, GUISELDA B (BSN RN)
Entity Type:Individual
Prefix:
First Name:GUISELDA
Middle Name:B
Last Name:SHANK
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER, 9040 JACKSON AVE
Mailing Address - Street 2:ATTN: MCHJ-CLQ-C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER, 9040 JACKSON AVE
Practice Address - Street 2:ATTN: MCHJ-CLQ-C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-967-2448
Practice Address - Fax:253-967-4859
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00145166163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management