Provider Demographics
NPI:1508088428
Name:SHANABERGER, PATRICIA LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:SHANABERGER
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 1:10110 WOODWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:915-590-7158
Mailing Address - Fax:
Practice Address - Street 1:1001 N. EL PASO STREET
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-831-4495
Practice Address - Fax:915-831-4449
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570415261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health