Provider Demographics
NPI:1396444212
Name:HANSON, SHANNON LEROY (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEROY
Last Name:HANSON
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 WILLOW TOP DR
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3626
Mailing Address - Country:US
Mailing Address - Phone:360-771-9935
Mailing Address - Fax:
Practice Address - Street 1:1628 WILLOW TOP DR
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-3626
Practice Address - Country:US
Practice Address - Phone:360-771-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily