Provider Demographics
NPI:1639207988
Name:BOHL, SHANNON MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MICHELLE
Last Name:BOHL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAMEDDAC WUERZBURG ATTN CREDENTIALS OFFICE
Mailing Address - Street 2:UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:US MEDDAC BAVARIA
Practice Address - Street 2:VILSECK HEALTH CLINIC
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:DE
Practice Address - Phone:314-590-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-98921-112163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN