Healthcare Provider Details

I. General information

NPI: 1437532983
Provider Name (Legal Business Name): SHALONDA NANCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 SUTHERLAND AVE
KNOXVILLE TN
37919-4576
US

IV. Provider business mailing address

3240 SUTHERLAND AVE
KNOXVILLE TN
37919-4576
US

V. Phone/Fax

Practice location:
  • Phone: 186-530-7665
  • Fax:
Mailing address:
  • Phone: 865-307-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number153102
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number153102
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number153102
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number153102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: