Provider Demographics
NPI:1255570271
Name:WINN, SHANNON LEIGH (MSN, ANP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:WINN
Suffix:
Gender:F
Credentials:MSN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 SHADOW CREEK PKWY APT 807
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7352
Mailing Address - Country:US
Mailing Address - Phone:910-723-9046
Mailing Address - Fax:
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-604-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1779363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health