Basic Information
Provider Information | |||||||||
NPI: | 1629258108 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DRAGOO | ||||||||
FirstName: | SHAWN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1900 10TH ST | ||||||||
Address2: |   | ||||||||
City: | ALAMOGORDO | ||||||||
State: | NM | ||||||||
PostalCode: | 883105053 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5754377404 | ||||||||
FaxNumber: | 5754392860 | ||||||||
Practice Location | |||||||||
Address1: | 206 SUDDERTH DR | ||||||||
Address2: |   | ||||||||
City: | RUIDOSO | ||||||||
State: | NM | ||||||||
PostalCode: | 883456001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5752575038 | ||||||||
FaxNumber: | 5752572312 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/13/2007 | ||||||||
LastUpdateDate: | 11/13/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN032523 | AZ | N |   | Nursing Service Providers | Registered Nurse |   | 163WP0808X | R56676 | NM | Y |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.