NPI 1235833302

Rose Lee Shaddon, TAXI

Practitioner Driver Russellville, AR

Practice location

Address: 705 Williamson Way, Russellville, AR 72801-6923
Phone: (479) 280-2132

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 0421-016067 (AR)

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Registry record

NPI: 1235833302
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Mar 2023
Record last updated: 30 Mar 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.