Provider Demographics
NPI:1033824693
Name:POTTER, SHANNON ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:POTTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWFIELDS
Mailing Address - State:NH
Mailing Address - Zip Code:03856-8406
Mailing Address - Country:US
Mailing Address - Phone:603-810-0002
Mailing Address - Fax:603-696-3547
Practice Address - Street 1:1 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:NEWFIELDS
Practice Address - State:NH
Practice Address - Zip Code:03856-8406
Practice Address - Country:US
Practice Address - Phone:603-810-0002
Practice Address - Fax:603-772-3601
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH080466-21163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty