Doctor Name: | MRS. SHANNON DUGE BARTELL |
NPI Number: | 1669720785 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 751834 |
Business Practice Address: | 12274 Bandera Rd Suite 106 Helotes, TX - 780234385 |
Business Phone Number: | 2103720505 |
Business Fax Number: | 2103720404 |
Mailing Address: | 12274 Bandera Rd, Suite 106 HELOTES |
State: | TX |
Postal Code: | 780234385 |
Phone Number: | 2103720505 |
Fax Number: | 2103720404 |
NPI Enumeration Date: | 08/21/2012 |
NPI Last Update Date: | 08/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 751834 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |