Provider Demographics
NPI:1114680709
Name:JUNIOR, SHANNON CONNOR (CRNA, APN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:CONNOR
Last Name:JUNIOR
Suffix:
Gender:F
Credentials:CRNA, APN
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:CONNOR
Other - Last Name:JUNIOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:658 N SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3834
Mailing Address - Country:US
Mailing Address - Phone:856-313-3798
Mailing Address - Fax:
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-755-1616
Practice Address - Fax:856-755-0098
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01217800367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered