Basic Information
| Provider Information | |||||||||
| NPI: | 1003867821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIBLER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | CAMILLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 89 BOX 328 | ||||||||
| Address2: | |||||||||
| City: | WILLOW | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996889704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077339265 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Practice Location | |||||||||
| Address1: | 34300 S TALKEETNA SPUR RD | ||||||||
| Address2: | |||||||||
| City: | TALKEETNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077339265 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 23477 | AK | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | CM7332 | 05 | AK | MEDICAID |