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General NPI Number Information
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NPI Number | 1306861778
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Entity Type | Individual
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Provider Name | SHAUNA M LARGE FNP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 16000 JOHNSTON MEMORIAL DR SUITE 304
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-3600
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Fax | 276-258-3605
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Provider Business Mailing Address
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Address Line | 16000 JOHNSTON MEMORIAL DR SUITE 304
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-3600
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Fax | 276-258-3605
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024165989
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8397
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License Number State | TN
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