Provider Demographics
NPI:1568278026
Name:HENDRICKSON, SHANNON (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 KIRKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19362-9033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1163 KENSINGTON LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1415
Practice Address - Country:US
Practice Address - Phone:215-901-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily