Provider Demographics
NPI:1073941241
Name:SHOEMAKER, GARY (RN, CAC III)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:RN, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5288
Mailing Address - Country:US
Mailing Address - Phone:303-237-3599
Mailing Address - Fax:303-238-7828
Practice Address - Street 1:1949 WADSWORTH BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5288
Practice Address - Country:US
Practice Address - Phone:303-237-3599
Practice Address - Fax:303-238-7828
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0060921163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse