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General NPI Number Information
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NPI Number | 1316636913
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Entity Type | Organization
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Legal Business Name | EHEALTH 360
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 202 N 1ST ST
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City | DONAHUE
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State | IA
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Zip | 52746-7711
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Country | US
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Telephone | 863-221-2351
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Fax |
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Provider Business Mailing Address
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Address Line | 5789 CORDOVA RD
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City | ERIE
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State | IL
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Zip | 61250-9740
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Country | US
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Telephone | 186-322-1235
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Fax |
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Authorized Official
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Title or Position | APRN/OWNER
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Name | SHANNON DANIELLE FRY
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Credential | MSN, APRN FNP-C CME
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Telephone | 863-221-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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