Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024180253 | VA |
N | 363LG0600X | Nurse Practitioner - Gerontology | R149899 | MD |
NPI | 1013422682 |
---|---|
Provider Name | Stephanie Ellen Shank |
First Address | Winchester, VA 22601-2896 |
Second Address | Winchester, VA 22601-2894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2017 |
Last Update Date | 01/10/2021 |