Provider Demographics
NPI:1912187568
Name:WOZNICK, SHANNON J (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:WOZNICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MAPLE AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5376
Mailing Address - Country:US
Mailing Address - Phone:479-751-3722
Mailing Address - Fax:479-751-1099
Practice Address - Street 1:609 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-751-5711
Practice Address - Fax:479-751-1099
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219596367500000X
PARN527716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2104400OtherHIGHMARK
PA3713583000OtherIBC
PA11971038OtherCAQH
PA1585281OtherGATEWAY
PA50085971OtherCAPITAL ADVANTAGE
PA127186OtherGEISINGER
PA9720452OtherAETNA
PA1020670570002Medicaid
PA2104400OtherFIRST PRIORITY
PA11971038OtherCAQH
PA127186OtherGEISINGER