Provider Demographics
NPI:1811661689
Name:ROGERS, SHANNON CLAIRE ROSE (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CLAIRE ROSE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON CLAIRE
Other - Middle Name:ROSE
Other - Last Name:UMANITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2258 LOVELL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SANBORNVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03872-4193
Mailing Address - Country:US
Mailing Address - Phone:978-270-0857
Mailing Address - Fax:
Practice Address - Street 1:2258 LOVELL LAKE RD
Practice Address - Street 2:
Practice Address - City:SANBORNVILLE
Practice Address - State:NH
Practice Address - Zip Code:03872-4193
Practice Address - Country:US
Practice Address - Phone:978-270-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276968163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice