Provider Demographics
NPI:1235808833
Name:WEBER, SHANNON E (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:WEBER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:ROESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3902 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2249
Mailing Address - Country:US
Mailing Address - Phone:410-887-1003
Mailing Address - Fax:
Practice Address - Street 1:3902 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-2249
Practice Address - Country:US
Practice Address - Phone:410-887-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse