Provider Demographics
NPI:1124096193
Name:POE-AMES, SHAUNA ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:ELIZABETH
Last Name:POE-AMES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:E
Other - Last Name:POE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1214 E NATIONAL AVE STE 90A
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1214 E NATIONAL AVE STE 90A
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834
Practice Address - Country:US
Practice Address - Phone:812-442-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001969A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200531680Medicaid
Q52041Medicare UPIN
IN214040FMedicare PIN