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NPI Code Detail

MEDICARE: SHANA PORTER RN

MEDICARE: SHANA PORTER RN
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
1163W00000XRegistered Nurse28236389AIN

General Provider Information

NPI Number : 1174221964
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANA PORTER RN
Provider Business Mailing Address
First Line : 5927 WINTHROP AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-2674
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7150 CLEARVISTA DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-4699
Country : US
Telephone Number : 317-621-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 02/21/2023

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