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1164938544 NPI number — SHANA B ELLIS CRNP

NPI Number: 1164938544
Health Care Provider/Practitioner: SHANA B ELLIS CRNP

Information about “1164938544” NPI (SHANA B ELLIS CRNP) exists in 1164938544 in HTML format HTML  |  1164938544 in plain Text format TXT  |  1164938544 in PDF (Portable Document Format) PDF  |  1164938544 in an XML format XML  formats.

NPI Number : 1164938544 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164938544",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIS",
    "FirstName": "SHANA",
    "MiddleName": "B",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WHITE",
    "OtherFirstName": "SHANA",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CRNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5086 AL HIGHWAY 73",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRYANT",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "35958-4316",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4083 CLOUD SPRINGS RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RINGGOLD",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30736-8411",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-820-6143",
    "PracticeLocationAddressFaxNumber": "706-956-8171",
    "EnumerationDate": "12/20/2017",
    "LastUpdateDate": "07/09/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "1-145902",
        "LicenseNumberStateCode": "AL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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