Provider Demographics
NPI:1437820578
Name:PROPPER, SHANNON (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:PROPPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6715
Mailing Address - Country:US
Mailing Address - Phone:547-789-9929
Mailing Address - Fax:
Practice Address - Street 1:4103 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6715
Practice Address - Country:US
Practice Address - Phone:547-789-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9455820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse