Provider Demographics
NPI:1922633361
Name:LEWIS, SHANNON MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:LEWIS
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 1:2317 CONCORD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2813
Mailing Address - Country:US
Mailing Address - Phone:704-933-2101
Mailing Address - Fax:704-933-1150
Practice Address - Street 1:2317 CONCORD LAKE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2813
Practice Address - Country:US
Practice Address - Phone:704-933-2101
Practice Address - Fax:704-933-1150
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227788163W00000X, 163W00000X
NC5013333363LF0000X
VA0001212925163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse