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Individual
SHANNON FULLEN-ROBERTS
Active
Individual
SHANNON FULLEN-ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171744
VA
363LF0000X
Family Nurse Practitioner
25249
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245645118
—
VA
01
—
P01696407
RAILROAD MEDICARE
VA
05
—
Q024051
—
TN
Enumeration date
06/30/2014
Last updated
03/13/2024
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