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Individual

MR. SHANE DAVID ANDERSON

Active
Find providers by NPI
Individual

MR. SHANE DAVID ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP-C

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5009250
NC
363L00000X
Nurse Practitioner
71001
ID
363L00000X
Nurse Practitioner
Primary
A165967
IA
363LF0000X
Family Nurse Practitioner
5009250
NC

Other

Enumeration date
01/04/2017
Last updated
12/27/2022
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