Provider Demographics
NPI:1669857561
Name:SHOULDERS, LANA (PA)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:SHOULDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:MOULDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:515 MADISON ST APT 153
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-1661
Mailing Address - Country:US
Mailing Address - Phone:630-649-1530
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1512
Practice Address - Country:US
Practice Address - Phone:931-299-7378
Practice Address - Fax:931-299-7399
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant