Basic Information
| Provider Information | |||||||||
| NPI: | 1366590705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOEMAKE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN OPAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 BEDFORD WAY | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370645526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157903290 | ||||||||
| FaxNumber: | 6157948845 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 BEDFORD WAY | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370645526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157903290 | ||||||||
| FaxNumber: | 6157948845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0800X | RN047060 | TN | X | Nursing Service Providers | Registered Nurse | Orthopedic | 363AM0700X | OPA0805 | TN | X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.