Provider Demographics
NPI:1235591413
Name:WOLFINBARGER, SHANNON (CNM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WOLFINBARGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:THORNBRUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1407
Mailing Address - Country:US
Mailing Address - Phone:909-991-6062
Mailing Address - Fax:
Practice Address - Street 1:1201 E. HWY 18
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770
Practice Address - Country:US
Practice Address - Phone:605-867-3003
Practice Address - Fax:605-867-3305
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife