Provider Demographics
NPI:1699345629
Name:GARDNER, SHANNON (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 N MONTANA AVE STE A-1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4185
Mailing Address - Country:US
Mailing Address - Phone:406-992-2570
Mailing Address - Fax:833-544-0788
Practice Address - Street 1:820 N MONTANA AVE STE A-1
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4185
Practice Address - Country:US
Practice Address - Phone:406-992-2570
Practice Address - Fax:833-544-0788
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-176637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily