Healthcare Provider Details

I. General information

NPI: 1033709068
Provider Name (Legal Business Name): MONICA PAIGE SHAMBO MSN, CRNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 FAIRHOPE AVE
FAIRHOPE AL
36532-3608
US

IV. Provider business mailing address

8720 FAIRHOPE AVE
FAIRHOPE AL
36532-3608
US

V. Phone/Fax

Practice location:
  • Phone: 251-747-2237
  • Fax:
Mailing address:
  • Phone: 251-747-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-173607
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-173607
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: