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General NPI Number Information
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NPI Number | 1730434085
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Entity Type | Individual
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Provider Name | SHENEKA ANNETTE MCNICHOLS CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 600 VESTAVIA PKWY STE 251
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City | VESTAVIA
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State | AL
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Zip | 35216-7719
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Country | US
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Telephone | 205-419-7376
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Fax | 844-325-0578
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Provider Business Mailing Address
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Address Line | 600 VESTAVIA PKWY STE 251
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City | VESTAVIA
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State | AL
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Zip | 35216-7719
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Country | US
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Telephone | 205-419-7376
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Fax | 844-325-0578
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-100394
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License Number State | AL
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