MEDICARE: SHALANDA C VANN FNP-C, RN, IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	L-312369	NC
2	363LF0000X	Family Nurse Practitioner	5016922	NC

General Provider Information

NPI Number	:	1275253726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALANDA C VANN FNP-C, RN, IBCLC

Provider Business Mailing Address
First Line	:	111 S CHURCH ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2501
Country	:	US
Telephone Number	:	919-833-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S CHURCH ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2501
Country	:	US
Telephone Number	:	919-833-3111
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	08/19/2024

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