Provider Demographics
NPI:1801375027
Name:WASSEL, SHANNON LORRAINE-KONOPIK (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LORRAINE-KONOPIK
Last Name:WASSEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 BRONCO LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-4781
Mailing Address - Country:US
Mailing Address - Phone:512-267-1877
Mailing Address - Fax:
Practice Address - Street 1:8808 BRONCO LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645
Practice Address - Country:US
Practice Address - Phone:512-267-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily