Provider Demographics
NPI:1346227899
Name:GREMINGER, SHANNA CARLEE (DNP, MS, FNP, BC-ADM)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:CARLEE
Last Name:GREMINGER
Suffix:
Gender:F
Credentials:DNP, MS, FNP, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4706
Mailing Address - Country:US
Mailing Address - Phone:888-510-7357
Mailing Address - Fax:888-510-8057
Practice Address - Street 1:1818 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4706
Practice Address - Country:US
Practice Address - Phone:888-510-7357
Practice Address - Fax:888-510-8057
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR13170207RE0101X
VA0024171682207RE0101X
NC5015363363LF0000X, 207RE0101X
CA9057363LF0000X
VA0017141575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD375946YZDSOtherMEDICARE PTAN
CAWNP9057BMedicare PIN
MD375946YZDSOtherMEDICARE PTAN
CAP82953Medicare UPIN