Individual
SHANA RYAN NORDYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
13816 BORA BORA WAY APT 223, MARINA DEL REY, CA 90292-6866
(219) 331-9321
Mailing address
13816 BORA BORA WAY APT 223, MARINA DEL REY, CA 90292-6866
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
95033351
CA
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
95033351
CA
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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