Healthcare Provider Details

I. General information

NPI: 1518094887
Provider Name (Legal Business Name): SHANA ANNE NORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 NORTH RD
PERRYSBURG NY
14129-9746
US

IV. Provider business mailing address

2410 GOWANDA ZOAR RD
GOWANDA NY
14070-9770
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-1049
  • Fax: 716-532-0679
Mailing address:
  • Phone: 716-532-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number503093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: