Provider Demographics
NPI:1043263767
Name:PEDROW, SHANA E (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:E
Last Name:PEDROW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 BAPTISTE DRIVE
Mailing Address - Street 2:PO BOX 426
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071
Mailing Address - Country:US
Mailing Address - Phone:913-557-5678
Mailing Address - Fax:913-557-5681
Practice Address - Street 1:2102 BAPTISTE DRIVE
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071
Practice Address - Country:US
Practice Address - Phone:913-557-5678
Practice Address - Fax:913-557-5681
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S89053Medicare UPIN
KS033A141DMedicare ID - Type Unspecified