Provider Demographics
NPI:1689008500
Name:MILLER, SHANNON NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:NEW ENGLAND HEMATOLOGY ONCOLOGY
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-658-6000
Mailing Address - Fax:617-658-6001
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:NEW ENGLAND HEMATOLOGY ONCOLOGY
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-658-6000
Practice Address - Fax:617-658-6001
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner