Provider Demographics
NPI:1851953749
Name:BARTHOLOMEW, SHANE MICHELLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANE
Middle Name:MICHELLE
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:SHANE
Other - Middle Name:MICHELLE
Other - Last Name:BARTHOLOMEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:77 S COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8891
Mailing Address - Country:US
Mailing Address - Phone:484-526-3830
Mailing Address - Fax:833-213-6428
Practice Address - Street 1:59 ROSEBERRY ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1627
Practice Address - Country:US
Practice Address - Phone:908-847-4025
Practice Address - Fax:833-514-6843
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020199363LF0000X
NJ26NJ00915000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily