Individual
MR. GARY SHINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1971
(757) 668-7315
Mailing address
1661 SPRING HOUSE TRL, VIRGINIA BEACH, VA 23455-7005
(757) 282-9621
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
0001272766
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001272766
RN LICENSE
VA
Enumeration date
05/24/2022
Last updated
05/24/2022
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