Healthcare Provider Details

I. General information

NPI: 1003408360
Provider Name (Legal Business Name): ASHLEY THERESE SHANNAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 ROBINSON RD
HUDSON NH
03051-3059
US

IV. Provider business mailing address

33 FIRE RD 7
LANCASTER MA
01523-3045
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-6700
  • Fax:
Mailing address:
  • Phone: 978-319-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2338131
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number054849-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: