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Individual
SHANNETTE M AILES
Active
Individual
SHANNETTE M AILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71005432A
IN
363LF0000X
Family Nurse Practitioner
71005432A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11012677
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000938346
ANTHEM (REID PHYSICIAN ASSOCIATES, INC.)
IN
05
—
0128143
—
OH
05
—
201286480
—
IN
Enumeration date
04/22/2015
Last updated
05/20/2021
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