MEDICARE: ELISE MICHELLE SHAHAN FNP-C

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	363LF0000X	Family Nurse Practitioner	233874	AK

General Provider Information

NPI Number	:	1356148647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE MICHELLE SHAHAN FNP-C

Provider Business Mailing Address
First Line	:	1353 W CHENA HILLS DR
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-5752
Country	:	US
Telephone Number	:	907-750-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 W CHENA HILLS DR
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-5752
Country	:	US
Telephone Number	:	907-750-9620
Fax Number	:

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

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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