Provider Demographics
NPI:1205221744
Name:SHANAHAN, RUCSANDRA RALUCA (RN)
Entity Type:Individual
Prefix:
First Name:RUCSANDRA
Middle Name:RALUCA
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 CALDWELL LOOP
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8397
Mailing Address - Country:US
Mailing Address - Phone:478-213-5019
Mailing Address - Fax:
Practice Address - Street 1:273 CALDWELL LOOP
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-8397
Practice Address - Country:US
Practice Address - Phone:478-213-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC266367163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient