MEDICARE: NADINE SHIVERS 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	AP11334	AZ
2	363LP2300X	Primary Care Nurse Practitioner	AP11334	AZ
3	363LF0000X	Family Nurse Practitioner	5017099	NC

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	:	1578080578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE SHIVERS FNP-C

Provider Business Mailing Address
First Line	:	2909 MARKET ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1221
Country	:	US
Telephone Number	:	910-687-4888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 MARKET ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1221
Country	:	US
Telephone Number	:	910-687-4888
Fax Number	:

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

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	07/01/2023

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Directions to “ NADINE SHIVERS FNP-C” Practice Location

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