Healthcare Provider Details

I. General information

NPI: 1275253726
Provider Name (Legal Business Name): SHALANDA C VANN FNP-C, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S CHURCH ST
LOUISBURG NC
27549-2501
US

IV. Provider business mailing address

111 S CHURCH ST
LOUISBURG NC
27549-2501
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-3111
  • Fax:
Mailing address:
  • Phone: 919-833-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016922
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-312369
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: