Provider Demographics
NPI:1245277615
Name:MAASKE, SHANNON L (CNM)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:MAASKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-278-3203
Practice Address - Street 1:4011 OLD CLINIC BLDG CB#7570
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-3717
Practice Address - Country:US
Practice Address - Phone:919-843-2490
Practice Address - Fax:919-843-6938
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC485367A00000X
FLARNP9236921367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY090MOtherBLUE CROSS
FL307460900Medicaid
FLY090MOtherBLUE CROSS
FL307460900Medicaid