Provider Demographics
NPI:1972070498
Name:SHAHBAHRAMI, CARRIE (MSN,RXN,CNS,ACCNS-AG)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:SHAHBAHRAMI
Suffix:
Gender:F
Credentials:MSN,RXN,CNS,ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:970-433-7671
Practice Address - Street 1:1006 N 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7561
Practice Address - Country:US
Practice Address - Phone:970-579-0003
Practice Address - Fax:970-433-7671
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994139-CNS364SA2100X
COAPN.0995365-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care