Healthcare Provider Details

I. General information

NPI: 1326688870
Provider Name (Legal Business Name): SHANNON COLLEEN TROSPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 LAMBERT RD
BISCOE NC
27209-9002
US

IV. Provider business mailing address

401 LAMBERT RD
BISCOE NC
27209-9002
US

V. Phone/Fax

Practice location:
  • Phone: 910-428-2117
  • Fax:
Mailing address:
  • Phone: 910-428-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number277004579
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71017373A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: