Basic Information
| Provider Information | |||||||||
| NPI: | 1649352899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEARY | ||||||||
| FirstName: | SHANA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 STATE ROUTE 654 N | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420645469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709652131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 131 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420788043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709882299 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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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 | 367500000X | 3005005 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 000000497580 | 01 | KY | ANTHEM BCBS PIN | OTHER | 3005005 | 01 | KY | LICENSE | OTHER |