Provider Demographics
NPI:1720545452
Name:MURLEY, SHANNON MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:MURLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 POND WAY STE 170
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5596
Mailing Address - Country:US
Mailing Address - Phone:571-542-4950
Mailing Address - Fax:571-285-1160
Practice Address - Street 1:4500 POND WAY STE 170
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5596
Practice Address - Country:US
Practice Address - Phone:571-542-4950
Practice Address - Fax:571-285-1160
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190006493363LF0000X
VA0024178893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily