MEDICARE: MRS. CLAUDINE A. SHANK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	114275	CO
2	367500000X	Certified Registered Nurse Anesthetist	APN.0004377-CRNA	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174517494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLAUDINE A. SHANK CRNA

Provider Business Mailing Address
First Line	:	3631 TUSCANNA GRV
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2820
Country	:	US
Telephone Number	:	719-219-9573
Fax Number	:	719-219-9573

Provider Business Practice Location Address
First Line	:	3631 TUSCANNA GRV
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2820
Country	:	US
Telephone Number	:	719-219-9573
Fax Number	:	719-219-9573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	11/06/2019

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