Provider Demographics
NPI:1952506156
Name:PUTZEL, SHANNON DOREEN (RNC, WHNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DOREEN
Last Name:PUTZEL
Suffix:
Gender:F
Credentials:RNC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. ALTON GLOOR BLVD
Mailing Address - Street 2:BLDG B, STE 130
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3328
Mailing Address - Country:US
Mailing Address - Phone:956-350-4821
Mailing Address - Fax:956-350-6718
Practice Address - Street 1:100 E. ALTON GLOOR BLVD
Practice Address - Street 2:BLDG B, STE 130
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-7852
Practice Address - Country:US
Practice Address - Phone:956-350-4821
Practice Address - Fax:956-350-6718
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110103363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health