Provider Demographics
NPI:1225360316
Name:WHITE, SHANNON CRAIG (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:CRAIG
Last Name:WHITE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:318 COFFEE AVE NE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2331
Mailing Address - Country:US
Mailing Address - Phone:256-332-1629
Mailing Address - Fax:256-332-4178
Practice Address - Street 1:318 COFFEE AVE NE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2331
Practice Address - Country:US
Practice Address - Phone:256-332-1629
Practice Address - Fax:256-332-4178
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-124327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily