Provider Demographics
NPI:1558906578
Name:CALL, SHAUNDRA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:MARIE
Last Name:CALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1476
Mailing Address - Country:US
Mailing Address - Phone:859-588-8018
Mailing Address - Fax:
Practice Address - Street 1:131 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1476
Practice Address - Country:US
Practice Address - Phone:859-588-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily