Provider Demographics
NPI:1790158301
Name:MCSHANE, JOHN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MCSHANE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-6821
Mailing Address - Country:US
Mailing Address - Phone:609-929-9692
Mailing Address - Fax:
Practice Address - Street 1:758 STEEPLECHASE CT
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-6821
Practice Address - Country:US
Practice Address - Phone:609-929-9692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00599500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered