Provider Demographics
NPI:1861837437
Name:SHIVER, SHANDI (CRNP)
Entity Type:Individual
Prefix:
First Name:SHANDI
Middle Name:
Last Name:SHIVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WATCH TOWER
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3007
Mailing Address - Country:US
Mailing Address - Phone:251-367-3760
Mailing Address - Fax:
Practice Address - Street 1:1083 E RELHAM AVE
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-2406
Practice Address - Country:US
Practice Address - Phone:251-964-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily