Provider Demographics
NPI:1497870018
Name:HUGHES, SHANNON L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:L
Last Name:HUGHES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4154
Mailing Address - Country:US
Mailing Address - Phone:814-946-3801
Mailing Address - Fax:
Practice Address - Street 1:300 E PLANK RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4154
Practice Address - Country:US
Practice Address - Phone:814-946-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ15978Medicare UPIN