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General NPI Number Information
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NPI Number | 1255968954
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Entity Type | Individual
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Provider Name | SHANNON KOLUPAEVA RN
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 800 LAKESHORE DR
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City | BIRMINGHAM
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State | AL
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Zip | 35229-0002
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Country | US
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Telephone | 775-560-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 BROOKMEADOW LN
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City | RENO
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State | NV
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Zip | 89511-9000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 1-166204
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 64423
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License Number State | ID
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