Individual
SHANNON C BORMANN
Active
Individual
SHANNON C BORMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
28199577A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28199577A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001135802
ANTHEM PROVIDER NUMBER
IN
05
—
300009668
—
IN
Enumeration date
06/20/2017
Last updated
05/16/2025
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