Basic Information
| Provider Information | |||||||||
| NPI: | 1427451608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILES | ||||||||
| FirstName: | SHAWNA | ||||||||
| MiddleName: | RACHAEL | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 E BROADWAY AVE BOX 428 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 830010428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077397551 | ||||||||
| FaxNumber: | 8883295701 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 E BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 830018642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077397551 | ||||||||
| FaxNumber: | 8883295701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2014 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN-0992063-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 41718.1781 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.