Basic Information
| Provider Information | |||||||||
| NPI: | 1124206305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUNK | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E. LA HARPE ST | ||||||||
| Address2: | |||||||||
| City: | KIRKSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 635014520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6806651962 | ||||||||
| FaxNumber: | 6606653989 | ||||||||
| Practice Location | |||||||||
| Address1: | 1628 OKLAHOMA AVENUE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646832565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6603594600 | ||||||||
| FaxNumber: | 6603594286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2008 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 2015022174 | MO | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.