Provider Demographics
NPI:1336907740
Name:WROBEL, SHANNON ROSE WILLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE WILLE
Last Name:WROBEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7879 BRIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6362
Mailing Address - Country:US
Mailing Address - Phone:585-797-3437
Mailing Address - Fax:
Practice Address - Street 1:7879 BRIGHTON CT
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6362
Practice Address - Country:US
Practice Address - Phone:585-797-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily