Shannon, Tina Nannette

Shannon, Tina Nannette is an individual health care provider with primary practice located at 3200 Maccorkle Ave Se , Charleston WV 25304-1227. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Shannon, Tina Nannette can be contacted via phone (304) 388-5503.

Contact Information

Primary practice address
3200 Maccorkle Ave Se Charleston WV 25304-1227
Phone: (304) 388-5503
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 54626 West Virginia

Profile Details

NPI number 1265435556
LBN Legal business name Shannon, Tina Nannette
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Apr 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265435556 NPPES
West Virginia Other 27005299700 WORKER'S COMP-MAAC
West Virginia MEDICAID 2624413 WORKER'S COMP-MAAC
West Virginia Other 270052997 WORKER'S COMP-MAAC
West Virginia MEDICAID 2601300000 WORKER'S COMP-MAAC
West Virginia Other P00258571 WORKER'S COMP-MAAC
West Virginia Other 001713630 WORKER'S COMP-MAAC

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