Individual
SHANNON MOEGGENBORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
1105 SIXTH ST, TRAVERSE CITY, MI 49684-2349
(231) 947-0673
(801) 740-2847
Mailing address
4624 N SPIDER LAKE RD, TRAVERSE CITY, MI 49696-8440
(231) 947-0673
(801) 740-2847
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704265833
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B86032
BCBS
MI
Enumeration date
08/14/2014
Last updated
07/26/2023
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