Provider Demographics
NPI:1841621737
Name:SHATTLE, RENEE NICOLE (RN)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:NICOLE
Last Name:SHATTLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 ROCKHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3675
Mailing Address - Country:US
Mailing Address - Phone:727-804-9722
Mailing Address - Fax:
Practice Address - Street 1:2095 ROCKHURST BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3675
Practice Address - Country:US
Practice Address - Phone:727-804-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1624451163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical