Provider Demographics
NPI:1003408360
Name:SHANNAK, ASHLEY THERESE (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:THERESE
Last Name:SHANNAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FIRE RD 7
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-3045
Mailing Address - Country:US
Mailing Address - Phone:978-319-5729
Mailing Address - Fax:
Practice Address - Street 1:208 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3059
Practice Address - Country:US
Practice Address - Phone:603-882-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH054849-21163WG0000X
MARN2338131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice