Provider Demographics
NPI:1164601456
Name:IKENBERRY, SHANNON MARSHALL (RNC, WHNP)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:MARSHALL
Last Name:IKENBERRY
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 EVELYN BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5424
Mailing Address - Country:US
Mailing Address - Phone:540-434-3831
Mailing Address - Fax:540-437-7451
Practice Address - Street 1:9 S MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2333
Practice Address - Country:US
Practice Address - Phone:540-932-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167121363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health