Shane Carllson, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

27765 Issued in AK

Practice address

829 Cheif Eddie Hoffman Hwy
Bethel, AK 99559

Phone

(907) 549-6809

Fax

(907) 543-7110

NPI assigned

Dec 12, 2013

Last updated

Dec 12, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1861823106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 528",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "995590528",
            "telephone_number": "907-543-6809",
            "fax_number": "907-543-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 CHEIF EDDIE HOFFMAN HWY",
            "city": "BETHEL",
            "state": "AK",
            "postal_code": "99559",
            "telephone_number": "907-549-6809",
            "fax_number": "907-543-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLLSON",
        "first_name": "SHANE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-12",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "27765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020986",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loretta Carl
• Michelle M Carl
• Nicole Renee Carl
• Sabrina Carl
• Sarah Marie Carl
• Amy Carson-Strnad, M.D.
• Sally Carter
• Shantel Carter
• Marlo Karina Castelo, P.A-C
• Marie Nelda Celestin, PHARMD

• Registered Nurse in Bethel, AK
• Providers in Bethel, AK by specialty
• Registered Nurse in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.