Provider Demographics
NPI:1811977499
Name:HANNER, SHELIA G (MSN, FNP)
Entity type:Individual
Prefix:
First Name:SHELIA
Middle Name:G
Last Name:HANNER
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 SHALLOWFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1688
Mailing Address - Country:US
Mailing Address - Phone:423-266-6751
Mailing Address - Fax:423-763-4650
Practice Address - Street 1:601 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1922
Practice Address - Country:US
Practice Address - Phone:423-266-6751
Practice Address - Fax:423-763-4650
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6546363LF0000X
TNRN0000087880163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3905650Medicaid
TN500028964OtherRAILROAD MEDICARE
TNP00313Medicare UPIN
TN3905652Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO