Provider Demographics
NPI:1962079525
Name:MCCARTER, SHANNON RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:MCCARTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:R
Other - Last Name:FIELDS, ARROYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:
Practice Address - Street 1:10110 DONALD S POWERS DR STE 202
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4070
Practice Address - Country:US
Practice Address - Phone:219-922-8222
Practice Address - Fax:219-922-8377
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011197A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300053721Medicaid