Provider Demographics
NPI:1184197543
Name:ROBERTSON, SHANNON STEFAN (CRNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:STEFAN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LYNN
Other - Last Name:STEFAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 WOODBINE DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3212
Mailing Address - Country:US
Mailing Address - Phone:724-513-6292
Mailing Address - Fax:
Practice Address - Street 1:2719 BRODHEAD RD STE 190
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2793
Practice Address - Country:US
Practice Address - Phone:724-419-9200
Practice Address - Fax:724-419-9202
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily