Provider Demographics
NPI:1740342112
Name:ZELLMER, SHAWN MARIE (RN, MSN, CPNP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:ZELLMER
Suffix:
Gender:
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 NC HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9232
Mailing Address - Country:US
Mailing Address - Phone:252-791-3111
Mailing Address - Fax:
Practice Address - Street 1:198 NC HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9232
Practice Address - Country:US
Practice Address - Phone:252-791-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114434163W00000X
NC300318363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC114434OtherLICENSE FOR RN
NC300318OtherSTATE MEDICAL BOARD LICEN
NC300318OtherSTATE MEDICAL BOARD LICEN