Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | PENDING | IN |
NPI | 1033792841 |
---|---|
Provider Name | Shana Lynn Norris |
First Address | Cincinnati, OH 45263-7273 |
Second Address | Newburgh, IN 47630-8940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2021 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28188425A | RN LICENSE (01) | IN |
71011326A | APRN LICENSE (01) | IN |