Individual
SHANE MICHAEL CLARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN FNP-C
Contact information
Practice address
1901 TATE SPRINGS RD, LYNCHBURG, VA 24501-1109
(434) 200-3000
Mailing address
3122 CORBIESHAW RD SW, ROANOKE, VA 24015-4618
(434) 594-4716
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001262949
VA
363L00000X
Nurse Practitioner
Primary
0024179611
VA
Other
Enumeration date
05/08/2020
Last updated
06/30/2020
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