Provider Demographics
NPI:1679086839
Name:WARD, SHANNON KELLY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KELLY
Last Name:WARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-314-6900
Mailing Address - Fax:603-314-6909
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-314-6900
Practice Address - Fax:603-314-6909
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056737-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty