Provider Demographics
NPI:1356376628
Name:MCCARDLE, SHANA L (CNM)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:L
Last Name:MCCARDLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 CAMPBELL STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701
Mailing Address - Country:US
Mailing Address - Phone:570-327-9900
Mailing Address - Fax:570-327-9400
Practice Address - Street 1:904 CAMPBELL STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-327-9900
Practice Address - Fax:570-327-9400
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9182579363LX0001X
PAMW010119176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275914400Medicaid