Provider Demographics
NPI:1881028553
Name:NALE, SHANNON M (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:NALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 E TRAINER LN
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IN
Mailing Address - Zip Code:47165-7213
Mailing Address - Country:US
Mailing Address - Phone:812-967-3800
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST STE 104
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6802
Practice Address - Country:US
Practice Address - Phone:812-944-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28147839A163W00000X
INA0813063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse