Provider Demographics
NPI:1407176480
Name:GERBER, SHANNON BETH (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BETH
Last Name:GERBER
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:BETH
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4570 HAGERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7535
Mailing Address - Country:US
Mailing Address - Phone:928-853-3123
Mailing Address - Fax:
Practice Address - Street 1:1918 CREST HAVEN CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2901
Practice Address - Country:US
Practice Address - Phone:719-761-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3672363LA2200X
CO990039363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04927273Medicaid
COCOAAA3349Medicare UPIN