Provider Demographics
NPI:1326590282
Name:SHIRAH, ELAINE N (FNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:N
Last Name:SHIRAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7335
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7335
Mailing Address - Country:US
Mailing Address - Phone:706-320-3128
Mailing Address - Fax:706-320-3230
Practice Address - Street 1:6003 VETERANS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6284
Practice Address - Country:US
Practice Address - Phone:706-223-1933
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily