Provider Demographics
NPI:1003306945
Name:FOLGA, SHANNON R (MSN, CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:FOLGA
Suffix:
Gender:F
Credentials:MSN, CRNA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RAE
Other - Last Name:MARKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 BOYER RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-2506
Mailing Address - Country:US
Mailing Address - Phone:814-450-0776
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550
Practice Address - Country:US
Practice Address - Phone:814-450-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA649819163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse