Provider Demographics
NPI:1598926230
Name:SHANHOLTZER, JEANETTE MARJORIE (RNC MSN APRN WHNP)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARJORIE
Last Name:SHANHOLTZER
Suffix:
Gender:F
Credentials:RNC MSN APRN WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-1465
Mailing Address - Country:US
Mailing Address - Phone:816-719-5109
Mailing Address - Fax:
Practice Address - Street 1:1535 NE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4611
Practice Address - Country:US
Practice Address - Phone:816-525-0907
Practice Address - Fax:816-525-1664
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9402822363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health