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General NPI Number Information
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NPI Number | 1285972067
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Entity Type | Individual
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Provider Name | SHANNON LEE RADACI CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 5609 5TH AVE HEARTLAND CARE PARTNERS
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City | PITTSBURGH
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State | PA
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Zip | 15232-2601
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Country | US
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Telephone | 800-375-5495
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Fax | 800-564-5952
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Provider Business Mailing Address
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Address Line | 1389 SAMANTHA WAY
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City | NORTH HUNTINGDON
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State | PA
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Zip | 15642-5800
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP012506
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License Number State | PA
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