Healthcare Provider Details

I. General information

NPI: 1376860023
Provider Name (Legal Business Name): SHANA CRIPE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 07/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVE OPD 3P-61
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

23037 SERRA DR
CARSON CA
90745-4968
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-3961
  • Fax:
Mailing address:
  • Phone: 310-834-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18419
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number616421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: