Provider Demographics
NPI:1336104819
Name:SHOULDERS, JEANNE M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:M
Last Name:SHOULDERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:PAUL
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:901 MAPLE ST
Mailing Address - Street 2:SUITES ON MAPLE EAST, SUITE G-65
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15705-1074
Mailing Address - Country:US
Mailing Address - Phone:724-357-2550
Mailing Address - Fax:724-357-6212
Practice Address - Street 1:1097 OAK STREET
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-349-2022
Practice Address - Fax:724-349-8735
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN522348L163W00000X
PASP008108363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1991407OtherHIGHMARK
PAMC1584937OtherHIGHMARK