MEDICARE: MS. SHANNA CARTI' HASSELL HS(HEALTH SERV.TECH)

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	146N00000X	Basic Emergency Medical Technician	B1662166	VA

General Provider Information

NPI Number	:	1982674180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNA CARTI' HASSELL HS(HEALTH SERV.TECH)

Provider Business Mailing Address
First Line	:	314 ROUNDTREE DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7872
Country	:	US
Telephone Number	:	252-338-2489
Fax Number	:	252-334-5420

Provider Business Practice Location Address
First Line	:	1183 WEEKSVILLE RD
Second Line	:	BLDG 128
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-8437
Country	:	US
Telephone Number	:	252-335-6524
Fax Number	:	252-334-5420

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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