MEDICARE: ALICIA MARIE SHANKS

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	363LW0102X	Women's Health Nurse Practitioner	RN302973	OH
2	163W00000X	Registered Nurse	RN08809	OH

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	:	1659399004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MARIE SHANKS

Provider Business Mailing Address
First Line	:	1511 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43222-1000
Country	:	US
Telephone Number	:	614-222-3525
Fax Number	:	614-222-3608

Provider Business Practice Location Address
First Line	:	1511 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43222-1000
Country	:	US
Telephone Number	:	614-222-3525
Fax Number	:	614-222-3608

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/16/2017

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Directions to “ ALICIA MARIE SHANKS ” Practice Location

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