NPI 1033377833 · live from the CMS NPI Registry
Brenna Mae Shackelford, MD
Emergency Medicine, Hospice and Palliative Medicine in Meridian, ID. National Provider Identifier 1033377833, active.
NPI record
| NPI | 1033377833 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Emergency Medicine, Hospice and Palliative Medicine 207PH0002X |
| Practice location | 520 S Eagle Rd Ste 3102, Meridian, ID 83642 |
| Practice phone | 208-381-1615 |
| Mailing address | 190 E Bannock St, Boise, ID 83712 |
| Enumerated | May 28, 2008 |
| Last updated | August 6, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Emergency Medicine | 207P00000X | MD19340 (HI) |
| Emergency Medicine | 207P00000X | 01067626A (IN) |
| Emergency Medicine | 207P00000X | 23824 (NV) |
| Emergency Medicine | 207P00000X | A133488 (CA) |
| Emergency Medicine | 207P00000X | M15461 (ID) |
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Emergency Medicine, Hospice and Palliative Medicine primary | 207PH0002X | M-15461 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.