Provider Demographics
NPI:1003293762
Name:WOOD, SHANNON M (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:WOOD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9016
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:9209 PHOENIX VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4280
Practice Address - Country:US
Practice Address - Phone:636-561-4613
Practice Address - Fax:636-561-4610
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015007598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily