Provider Demographics
NPI:1467661264
Name:HEMENWAY, SHANNON JEAN (APRN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:HEMENWAY
Suffix:
Gender:F
Credentials:APRN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 HAMPTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4226
Mailing Address - Country:US
Mailing Address - Phone:912-264-0760
Mailing Address - Fax:
Practice Address - Street 1:3226 HAMPTON AVE STE A
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4226
Practice Address - Country:US
Practice Address - Phone:912-264-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180038NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health