Provider Demographics
NPI:1699179531
Name:MCCRORY, SHANNON MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARIE
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1270 N MARINE CORPS DR STE 101
Mailing Address - Street 2:PMB 216
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4331
Mailing Address - Country:US
Mailing Address - Phone:671-486-3563
Mailing Address - Fax:
Practice Address - Street 1:PMB 216, 1270 N MARINE CORPS DR STE 101
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GUAM
Practice Address - Zip Code:96913
Practice Address - Country:UM
Practice Address - Phone:671-486-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNPO147367500000X
WI163398-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered