Provider Demographics
NPI:1154865350
Name:CARTER, SHANNA S (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:S
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E. VIRGINIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1202
Mailing Address - Country:US
Mailing Address - Phone:602-258-5545
Mailing Address - Fax:602-252-6115
Practice Address - Street 1:345 E. VIRGINIA AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1202
Practice Address - Country:US
Practice Address - Phone:602-258-5545
Practice Address - Fax:602-252-6115
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2019-08-07
Deactivation Date:2018-12-05
Deactivation Code:
Reactivation Date:2018-12-27
Provider Licenses
StateLicense IDTaxonomies
AZAP10232363LF0000X
AZRN116313163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH1000XNursing Service ProvidersRegistered NurseHospice