Provider Demographics
NPI:1356148647
Name:SHAHAN, ELISE MICHELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MICHELLE
Last Name:SHAHAN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 W CHENA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5752
Mailing Address - Country:US
Mailing Address - Phone:907-750-9620
Mailing Address - Fax:
Practice Address - Street 1:1353 W CHENA HILLS DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5752
Practice Address - Country:US
Practice Address - Phone:907-750-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK233874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily