Basic Information
| Provider Information | |||||||||
| NPI: | 1851662167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | HO | ||||||||
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| Credential: | PHD, NP-C | ||||||||
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| OtherLastName: | HO | ||||||||
| OtherFirstName: | NANCY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 508 FULTON STREET | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199668436 | ||||||||
| FaxNumber: | 9199668440 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 FULTON STREET | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | 9199668440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2012 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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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 | 363LA2200X | 244411 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.