Healthcare Provider Details

I. General information

NPI: 1043034846
Provider Name (Legal Business Name): SHANE DAVID KARPOWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S MEMORIAL DR
PRATTVILLE AL
36067-3619
US

IV. Provider business mailing address

124 S MEMORIAL DR
PRATTVILLE AL
36067-3619
US

V. Phone/Fax

Practice location:
  • Phone: 334-365-0651
  • Fax:
Mailing address:
  • Phone: 334-365-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-174848
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: