Provider Demographics
NPI:1932146917
Name:SHADLE, CATHY SUE (MSN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:SUE
Last Name:SHADLE
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4208
Mailing Address - Country:US
Mailing Address - Phone:717-264-7306
Mailing Address - Fax:
Practice Address - Street 1:100 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2421
Practice Address - Country:US
Practice Address - Phone:717-218-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005858B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019445370003Medicaid
PAP97879Medicare UPIN
PA073145RNAMedicare ID - Type Unspecified