Provider Demographics
NPI:1619768959
Name:MINER, SHANE EDWARD (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:EDWARD
Last Name:MINER
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:SHANE
Other - Middle Name:EDWARD
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SHANE MINER RN
Mailing Address - Street 1:201 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2261
Mailing Address - Country:US
Mailing Address - Phone:724-812-2741
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily