Provider Demographics
NPI:1588359210
Name:DUMMER, SHANNON LEIGH (DNP, FNP, CEN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEIGH
Last Name:DUMMER
Suffix:
Gender:F
Credentials:DNP, FNP, CEN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6408 ZITTLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-6202
Mailing Address - Country:US
Mailing Address - Phone:240-506-3693
Mailing Address - Fax:
Practice Address - Street 1:12916 CONAMAR DR STE 204
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2773
Practice Address - Country:US
Practice Address - Phone:301-791-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR246089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily