Provider Demographics
NPI:1952698144
Name:SHANITA WEBB
Entity Type:Organization
Organization Name:SHANITA WEBB
Other - Org Name:SHANITA WEBB
Other - Org Type:Other Name
Authorized Official - Title/Position:MATERNAL CHILD FLIGHT COMMANDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAVRA
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:318-630-4817
Mailing Address - Street 1:PSC 80 BOX 16268
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5142
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5142
Practice Address - Country:US
Practice Address - Phone:318-630-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital