Shana Ryan Nordyke, NP

Primary specialty

Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X

License

95033351 Issued in CA

Practice address

13816 Bora Bora Way Apt 223
Marina del Rey, CA 90292-6866

Phone

(219) 331-9321

NPI assigned

Dec 20, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1734652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1982412060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13816 BORA BORA WAY APT 223",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13816 BORA BORA WAY APT 223",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926866",
            "telephone_number": "219-331-9321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "608 Coventry Cir",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463832002",
            "country_code": "US",
            "telephone_number": "219-331-9321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NORDYKE",
        "first_name": "SHANA",
        "middle_name": "RYAN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-20",
        "last_updated": "2024-12-20",
        "certification_date": "2024-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95033351",
            "primary": false
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "CA",
            "license": "95033351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Critical Care Medicine Nurse Practitioner in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Critical Care Medicine Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; 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.