Healthcare Provider Details

I. General information

NPI: 1649352899
Provider Name (Legal Business Name): SHANA W GEARY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 HOSPITAL DR
SALEM KY
42078-8043
US

IV. Provider business mailing address

1450 STATE ROUTE 654 N
MARION KY
42064-5469
US

V. Phone/Fax

Practice location:
  • Phone: 270-988-2299
  • Fax:
Mailing address:
  • Phone: 270-965-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3005005
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: