Provider Demographics
NPI:1528742442
Name:GODSAVE, SHANNON RUSSELL (CRNP)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:RUSSELL
Last Name:GODSAVE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:MR
Other - First Name:SHANNON
Other - Middle Name:RUSSELL
Other - Last Name:GODSAVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1330 HIGHWAY 231 S
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3067
Mailing Address - Country:US
Mailing Address - Phone:334-670-5000
Mailing Address - Fax:
Practice Address - Street 1:1330 HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3067
Practice Address - Country:US
Practice Address - Phone:334-670-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily