Provider Demographics
NPI:1063882660
Name:BOMBERGER, SHANNON (CPM, RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:BOMBERGER
Suffix:
Gender:F
Credentials:CPM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9242
Mailing Address - Country:US
Mailing Address - Phone:717-327-0099
Mailing Address - Fax:
Practice Address - Street 1:35 SUNSET DR
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9242
Practice Address - Country:US
Practice Address - Phone:717-327-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR191354207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics