Provider Demographics
NPI:1558601450
Name:BUSTER, SHANNON NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICOLE
Last Name:BUSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 GOLD COAST DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4498
Mailing Address - Country:US
Mailing Address - Phone:402-201-2300
Mailing Address - Fax:
Practice Address - Street 1:754 GOLD COAST DR STE 105
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4498
Practice Address - Country:US
Practice Address - Phone:402-201-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1724363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical