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NPI Code Detail

MEDICARE: SHANTELLE M BURRESS NP

MEDICARE: SHANTELLE M BURRESS NP
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
1363LF0000XFamily Nurse Practitioner71007967AIN

General Provider Information

NPI Number : 1285124727
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTELLE M BURRESS NP
Provider Business Mailing Address
First Line : 51100 OAK LINED DR
Second Line :
City : GRANGER
State : IN
Zip : 46530-7531
Country : US
Telephone Number : 810-701-6599
Fax Number :
Provider Business Practice Location Address
First Line : 130 E CLEVELAND RD
Second Line :
City : GRANGER
State : IN
Zip : 46530-5620
Country : US
Telephone Number : 574-247-2221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2018
Last Update Date : 05/10/2018

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