Provider Demographics
NPI:1619952504
Name:MCSHANE, ANNE M (MSN CS RNC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:MSN CS RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WOODED WAY
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2133
Mailing Address - Country:US
Mailing Address - Phone:610-353-6468
Mailing Address - Fax:610-353-6468
Practice Address - Street 1:721 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-353-6468
Practice Address - Fax:610-353-6468
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN128654L364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2318851000OtherBCBS HIGHMARK