Provider Demographics
NPI:1942570585
Name:LAWRENCE, SHANNON CORNATZER (MSN, NNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CORNATZER
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MSN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2424 ERWIN RD
Mailing Address - Street 2:SUITE 504, NEONATOLOGY
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3824
Mailing Address - Country:US
Mailing Address - Phone:919-970-9004
Mailing Address - Fax:919-681-6065
Practice Address - Street 1:5524 HOSPITAL N
Practice Address - Street 2:BOX 100500 MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-970-9004
Practice Address - Fax:919-681-6065
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC214064363LN0005X
NC5004720363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care