Provider Demographics
NPI:1154567675
Name:O'BRIEN, SHANNON MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 370
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4007
Mailing Address - Country:US
Mailing Address - Phone:567-283-6368
Mailing Address - Fax:856-728-3633
Practice Address - Street 1:239 HURFFVILLE CROSSKEYS RD STE 370
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-728-3636
Practice Address - Fax:856-728-3633
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010097363LA2100X
NJ26NJ00867800363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care