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General NPI Number Information
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NPI Number | 1528742442
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Entity Type | Individual
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Provider Name | SHANNON RUSSELL GODSAVE CRNP
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 1330 HIGHWAY 231 S
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City | TROY
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State | AL
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Zip | 36081-3067
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Country | US
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Telephone | 334-670-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 HIGHWAY 231 S
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City | TROY
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State | AL
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Zip | 36081-3067
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Country | US
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Telephone | 334-670-5000
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-105099
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License Number State | AL
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