Provider Demographics
NPI:1891185906
Name:HANICK, SHALIZA (APRN)
Entity Type:Individual
Prefix:
First Name:SHALIZA
Middle Name:
Last Name:HANICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHALIZA
Other - Middle Name:
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 KNOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2109
Mailing Address - Country:US
Mailing Address - Phone:706-424-6744
Mailing Address - Fax:
Practice Address - Street 1:325 KNOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2109
Practice Address - Country:US
Practice Address - Phone:706-424-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216869363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care