Provider Demographics
NPI:1316451594
Name:FRASER, SHANNA RENEE (PHD, RN, ACNS-BC)
Entity type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:RENEE
Last Name:FRASER
Suffix:
Gender:F
Credentials:PHD, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312572
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-2572
Mailing Address - Country:US
Mailing Address - Phone:210-452-3713
Mailing Address - Fax:
Practice Address - Street 1:3323 ASHLEYS WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:TX
Practice Address - Zip Code:78124-1376
Practice Address - Country:US
Practice Address - Phone:210-452-3713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124931364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health