Provider Demographics
NPI:1477226975
Name:PLASTER, SHANNEN ELAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNEN
Middle Name:ELAINE
Last Name:PLASTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 CRUMPACKER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6055
Mailing Address - Country:US
Mailing Address - Phone:336-409-1357
Mailing Address - Fax:
Practice Address - Street 1:215 GILBERT ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3305
Practice Address - Country:US
Practice Address - Phone:540-961-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily