MEDICARE: VALERIE SHANER SHANER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN104695L	PA

General Provider Information

NPI Number	:	1023135514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE SHANER SHANER LPN

Provider Business Mailing Address
First Line	:	691 GLADE RUN RD
Second Line	:
City	:	KITTANNING
State	:	PA
Zip	:	16201-7447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 N HIGHLAND AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-2526
Country	:	US
Telephone Number	:	412-968-0562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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