MEDICARE: SHANNON ROUSE CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP020574	PA

General Provider Information

NPI Number	:	1922652460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ROUSE CRNP

Provider Business Mailing Address
First Line	:	603 WASHINGTON RD STE 300
Second Line	:
City	:	MT LEBANON
State	:	PA
Zip	:	15228-1928
Country	:	US
Telephone Number	:	412-563-6151
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 WASHINGTON RD STE 300
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1928
Country	:	US
Telephone Number	:	412-563-6151
Fax Number	:	412-344-3780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	03/23/2021

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Directions to “ SHANNON ROUSE CRNP” Practice Location

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