Provider Demographics
NPI:1811391022
Name:DUESCHER, SHANNON RASMUSSEN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RASMUSSEN
Last Name:DUESCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 KINDERKAMACK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-342-2550
Mailing Address - Fax:201-342-7171
Practice Address - Street 1:3800 RESERVOIR RD NW # 7PHC
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-4972
Practice Address - Fax:202-444-7333
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00349500OtherLICIENSE