Provider Demographics
NPI:1629344981
Name:WILSON, SHANNON L (CNM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:175 E BROWN ST
Practice Address - Street 2:SUITE 113
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-421-3401
Practice Address - Fax:570-421-0560
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
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Provider Licenses
StateLicense IDTaxonomies
PAMW010264367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife