Provider Demographics
NPI:1013494970
Name:STANDISH, SHANNON BUMGARDNER (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BUMGARDNER
Last Name:STANDISH
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Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-731-6857
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:2544 COURT DR STE F
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-864-8302
Practice Address - Fax:704-864-0228
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2023-12-13
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Provider Licenses
StateLicense IDTaxonomies
NC5010723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner