Provider Demographics
NPI:1871207746
Name:DAGGS, SHANDY NICHOLE (RN)
Entity type:Individual
Prefix:
First Name:SHANDY
Middle Name:NICHOLE
Last Name:DAGGS
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 1:2001 VILLA DR APT 304
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7941
Mailing Address - Country:US
Mailing Address - Phone:601-686-1836
Mailing Address - Fax:
Practice Address - Street 1:2001 VILLA DR APT 304
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-7941
Practice Address - Country:US
Practice Address - Phone:601-686-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95055959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse