Individual
NICOLE SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
406 CHATHAM SQUARE OFFICE PARK, FREDERICKSBURG, VA 22405-2585
(540) 666-6181
Mailing address
406 CHATHAM SQUARE OFFICE PARK, FREDERICKSBURG, VA 22405-2585
(540) 903-4135
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0110009187
VA
363AM0700X
Medical Physician Assistant
0110009187
VA
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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