Provider Demographics
NPI:1578564084
Name:AYERS, SHALEEN (CNS)
Entity Type:Individual
Prefix:
First Name:SHALEEN
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SAINT MARYS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 SAINT MARYS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0520
Practice Address - Country:US
Practice Address - Phone:812-473-2642
Practice Address - Fax:812-474-4458
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000071A364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S94988Medicare UPIN
INM400031555Medicare PIN
IN70000071AOtherIN LICENSE
S94988Medicare UPIN