Provider Demographics
NPI:1437536315
Name:NORBERG, SHANA ELIZABETH (CNM LM)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:ELIZABETH
Last Name:NORBERG
Suffix:
Gender:F
Credentials:CNM LM
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:ELIZABETH
Other - Last Name:NORBERG-MCCLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM LM
Mailing Address - Street 1:411 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5611
Mailing Address - Country:US
Mailing Address - Phone:917-676-9054
Mailing Address - Fax:718-865-5111
Practice Address - Street 1:411 RUGBY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5611
Practice Address - Country:US
Practice Address - Phone:917-676-9054
Practice Address - Fax:718-865-5111
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576310-1163W00000X
NYF001431-1367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife