Provider Demographics
NPI:1336694082
Name:ROBISON, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2782
Mailing Address - Country:US
Mailing Address - Phone:512-715-3114
Mailing Address - Fax:512-715-3116
Practice Address - Street 1:200 COUNTY ROAD 340A
Practice Address - Street 2:BLDG II, SUITE B-C
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4537
Practice Address - Country:US
Practice Address - Phone:512-715-3114
Practice Address - Fax:512-715-3116
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131809363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care