Individual
SHANNON WANLESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP- BC
Contact information
Practice address
46 NEWMAN SPRINGS RD E, RED BANK, NJ 07701-1530
(732) 264-5500
Mailing address
46 NEWMAN SPRINGS RD E, RED BANK, NJ 07701-1530
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
26NR16099000
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ00661400
NJ
Other
Enumeration date
08/04/2016
Last updated
09/01/2016
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