Provider Demographics
NPI:1609073576
Name:GINGERELLI, SHANNON LYNN (APN-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:GINGERELLI
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SADDLE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1901
Mailing Address - Country:US
Mailing Address - Phone:973-267-2122
Mailing Address - Fax:
Practice Address - Street 1:11 SADDLE RD
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1901
Practice Address - Country:US
Practice Address - Phone:973-267-2122
Practice Address - Fax:973-267-4434
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00131500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00131500OtherADV. NURSE PRAC. LICENSE
NJ26NR10613300OtherREGISTERED NURSE LICENSE