Provider Demographics
NPI:1891742078
Name:MURPHY, SHANNAN R (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:R
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10108 BARRANDS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8028
Mailing Address - Country:US
Mailing Address - Phone:803-622-4262
Mailing Address - Fax:
Practice Address - Street 1:10108 BARRANDS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8028
Practice Address - Country:US
Practice Address - Phone:803-622-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN2633367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863OtherBLUE CHOICE
SC576007863OtherAETNA
SC576007863OtherCIGNA
SCAN1417Medicaid
SC576007863OtherUHC
SC576007863OtherBCBS
SC576007863OtherAETNA