Provider Demographics
NPI:1932627767
Name:SHADWICK, NATALLY ANN (RN)
Entity Type:Individual
Prefix:
First Name:NATALLY
Middle Name:ANN
Last Name:SHADWICK
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-0325
Mailing Address - Country:US
Mailing Address - Phone:864-723-7578
Mailing Address - Fax:864-882-4388
Practice Address - Street 1:314 HILLANDALE RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-2113
Practice Address - Country:US
Practice Address - Phone:864-723-7578
Practice Address - Fax:864-882-4388
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC228792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse