Basic Information
| Provider Information | |||||||||
| NPI: | 1639324114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOEBOTTOM | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 WRIGHT AVE | ||||||||
| Address2: | PO BOX 69 | ||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894634971 | ||||||||
| FaxNumber: | 9894664186 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 WRIGHT AVE | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894634971 | ||||||||
| FaxNumber: | 9894664186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2008 | ||||||||
| LastUpdateDate: | 11/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704069056 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.