Shannon Aifuwa, NURSE PRACTITIONER
Individual provider Active NPI Adult Health Nurse Practitioner · Glen Allen, VA
NPI 1386033702 · NPPES record last updated Jan 22, 2015
Key facts
- NPI
- 1386033702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 0024171617 (VA)
- Practice address
- 11331 W Broad St
129
Glen Allen, VA 23060-5805 - Phone
- (804) 364-0521
- NPI assigned
- Jan 22, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024171617 | VA | MD | Adult Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 0024171617 | VA | Yes |
| Gerontology Nurse Practitioner | 363LG0600X | 0024171617 | VA |
Addresses
Primary practice location
11331 W Broad St
129
Glen Allen, VA 23060-5805
Mailing address
11331 W Broad St
129
Glen Allen, VA 23060-5805
Other providers in Glen Allen, VA
- Affirmation Home Health LLC
- Arpita Aggarwal
- Mohamed Hassan Ahmed
- Rais Ahmed
- Syed Belal Ahsan
- Faiza S Akbar
- Moboluwaji Akinfolajimi
- Taher Al Tekreeti
- Raed Al-Mustafa
- Shoaib Alam
All providers in Glen Allen, VA · Adult Health Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.