Provider Demographics
NPI:1285267484
Name:SHADY, JOANNA (RN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:SHADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HIMANGO RD
Mailing Address - Street 2:
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733-9523
Mailing Address - Country:US
Mailing Address - Phone:218-390-2374
Mailing Address - Fax:
Practice Address - Street 1:60 HIMANGO RD
Practice Address - Street 2:
Practice Address - City:ESKO
Practice Address - State:MN
Practice Address - Zip Code:55733-9523
Practice Address - Country:US
Practice Address - Phone:218-390-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2472058163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health