HOLLY SHADLE (NPI# 1235631490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235631490 |
| Entity Type | Individual |
| Full Name | HOLLY SHADLE |
| Credential | CRNP |
| Practice Address |
740 High Street Suite 3002 Williamsport PA 17701-3102 |
| Mailing Address |
1201 Grampian Blvd Williamsport PA 17701-1900 |
| Practice Telephone | 5703212820 |
| Practice Fax Number | 5703212821 |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-03-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
SP018629 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
740 HIGH STREET SUITE 3002 |
| City | WILLIAMSPORT |
| State | PA |
| Zip Code | 17701-3102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356318497 | Scott Douglas Croll | Surgery | 740 High Street, Suite 1003, Williamsport, PA 17701-3100 | 2006-03-08 |
| 1871056556 | Enoch Shouzheng Tse | Student in an Organized Health Care Education/Training Program | 740 High Street, Suite 401, Williamsport, PA 17701 | 2019-04-10 |
| 1376005512 | Hadassah Esther Heeralall Mccray | Student in an Organized Health Care Education/Training Program | 740 High Street, Suite 4001, Williamsport, PA 17701 | 2019-04-05 |
| 1619478427 | Jordan Meyers | Physician Assistant | 740 High Street, Suite 1003, Williamsport, PA 17701-3100 | 2018-02-27 |
| 1881951762 | Natasha Rachell Alligood-percoco | Obstetrics & Gynecology | 740 High Street, Suite 1004, Williamsport, PA 17701-3100 | 2012-04-18 |
| 1770719882 | Susquehanna Physician Services | Nurse Practitioner | 740 High Street, Suite 1004, Williamsport, PA 17701-3100 | 2009-06-03 |
| 1487827002 | Susan E King | Social Worker | 740 High Street, Suite 4001, Williamsport, PA 17701-3100 | 2008-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184267809 | Charlene Angella Pitter | Nurse Practitioner | 170 Warren Ave, Williamsport, PA 17701 | 2019-10-25 |
| 1396395299 | Susan E Fetzer | Occupational Therapy Assistant | Upmc Susquehanna,625 West Edwin Street, Williamsport, PA 17701 | 2019-09-13 |
| 1184280984 | Craig Andrew Tuller | Student in an Organized Health Care Education/Training Program | Williamsport Family Medicine Residency, 740 High Street, Suite 4001, Williamsport, PA 17701 | 2019-05-16 |
| 1760048045 | Michael Harvey | Student in an Organized Health Care Education/Training Program | 740 High St. Suite 4001, Williamsport, PA 17701 | 2019-05-13 |
| 1275196008 | Olivia Fladmark | Student in an Organized Health Care Education/Training Program | Williamsport Family Medicine Residency 740 High St, Suite 4001, Williamsport, PA 17701 | 2019-04-17 |
| 1528551231 | Mark Hampton Chiropractic Inc. | Durable Medical Equipment & Medical Supplies | 1111 East 3rd Street, Williamsport, PA 17701 | 2018-06-08 |
| 1548710882 | Central Pennsylvania Rehabilitation Medicine, Inc | Physical Medicine & Rehabilitation | 460 River Ave Ste 1, Williamsport, PA 17701 | 2016-10-11 |
| 1376096784 | Christine Kessler | Physician Assistant | One College Ave, Penna. College of Tech, Pa Program Dif 123, Williamsport, PA 17701 | 2016-08-02 |
| 1629440276 | Matthew Ray Rebuck | Specialist/Technologist | 220 N Reach Rd, Williamsport, PA 17701 | 2015-10-22 |
| 1508237223 | Neihl Williamson | Physician Assistant | 1205 Grampian Blvd Ste 3c, Williamsport, PA 17701 | 2015-10-08 |
| Find all providers in zip 17701 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760941355 | Theresa Hershberger | Nurse Practitioner | 1100 Grampian Blvd Fl 3, Williamsport, PA 17701-1909 | 2019-03-14 |
| 1053910711 | Taylor Anne Yagel | Nurse Practitioner | 131 W Edwin St, Williamsport, PA 17701-6131 | 2020-10-22 |
| 1619440971 | Debra Kay Canellos | Nurse Practitioner | 700 High Street, Williamsport, PA 17701-3198 | 2019-01-09 |
| 1235611625 | Jeffrey M Tessman | Nurse Practitioner | 412 N Monroe St, Williamsport, IN 47993-1049 | 2018-08-31 |
| 1730671462 | Sarah Updegraff | Nurse Practitioner | 471 Hepburn St, Williamsport, PA 17701-6122 | 2018-05-30 |
| 1437653557 | Kelle Rae Steinbacher | Nurse Practitioner | 2300 E 3rd St, Williamsport, PA 17701-4004 | 2018-03-22 |
| 1073013785 | Jaclyn Craigin | Nurse Practitioner | 1731 Ringer Ln, Williamsport, IN 47993-8900 | 2018-02-19 |
| 1396263778 | Jennifer Renee Burnett | Nurse Practitioner | 3 Byrkit Dr, Williamsport, MD 21795-1158 | 2017-09-06 |
| 1659823953 | Leslie Erdman | Nurse Practitioner | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2016-11-03 |
| 1598219602 | Laura Bojko | Nurse Practitioner | 740 High St Ste 3002, Williamsport, PA 17701-3102 | 2016-08-05 |
| Find all providers in WILLIAMSPORT | ||||
| City | WILLIAMSPORT |
| Zip Code | 17701 |
Please comment or provide details below to improve the information on HOLLY SHADLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.