Provider Demographics
NPI:1124732102
Name:SHOTWELL, MARNIE (DNP, AGPCNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:
Last Name:SHOTWELL
Suffix:
Gender:
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 N CAPITAL OF TEXAS HWY STE 1110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7203
Mailing Address - Country:US
Mailing Address - Phone:336-516-2866
Mailing Address - Fax:
Practice Address - Street 1:103 WHITE DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-3221
Practice Address - Country:US
Practice Address - Phone:336-516-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5021046363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program