Provider Demographics
NPI:1073618906
Name:SHAHAN, CRAIG WILLIAM (RN)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:SHAHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9614
Mailing Address - Country:US
Mailing Address - Phone:830-792-2489
Mailing Address - Fax:
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-896-2020
Practice Address - Fax:830-792-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252699163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care