Provider Demographics
NPI:1174517494
Name:SHANK, CLAUDINE A (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CLAUDINE
Middle Name:A
Last Name:SHANK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 TUSCANNA GRV
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2820
Mailing Address - Country:US
Mailing Address - Phone:719-219-9573
Mailing Address - Fax:719-219-9573
Practice Address - Street 1:3631 TUSCANNA GRV
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2820
Practice Address - Country:US
Practice Address - Phone:719-219-9573
Practice Address - Fax:719-219-9573
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO114275163W00000X
COAPN.0004377-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200508120Medicaid