Provider Demographics
NPI:1194087262
Name:RABER, SHANNON HURLEY (CPNP-AC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:HURLEY
Last Name:RABER
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:BOX 0106
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0106
Mailing Address - Country:US
Mailing Address - Phone:415-476-3831
Mailing Address - Fax:415-476-9068
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:BOX 0106
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0106
Practice Address - Country:US
Practice Address - Phone:415-476-3831
Practice Address - Fax:415-476-9068
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18460363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics