MEDICARE: COURTNEY CHARLOTTE SHANAHAN APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	NUR-APRN-LIC-124361	MT

General Provider Information

NPI Number	:	1942748785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CHARLOTTE SHANAHAN APRN, FNP-C

Provider Business Mailing Address
First Line	:	1251 ASPEN VALLEY DR
Second Line	:
City	:	HAILEY
State	:	ID
Zip	:	83333-8704
Country	:	US
Telephone Number	:	406-531-7652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 W MAIN ST
Second Line	:	MARCUS DALY MEMORIAL HOSPITAL AND CLINICS
City	:	HAMILTON
State	:	MT
Zip	:	59840-2338
Country	:	US
Telephone Number	:	406-375-4823
Fax Number	:	406-375-4846

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

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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