Healthcare Provider Details

I. General information

NPI: 1306608229
Provider Name (Legal Business Name): SHANNON ROSE TRAINER ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 COAL VALLEY ROAD SUITE 570
JEFFERSON HILLS PA
15025-3729
US

IV. Provider business mailing address

575 COAL VALLEY ROAD SUITE 570
JEFFERSON HILLS PA
15025-3729
US

V. Phone/Fax

Practice location:
  • Phone: 412-469-7660
  • Fax: 412-469-7547
Mailing address:
  • Phone: 412-469-7660
  • Fax: 412-469-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP028403
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: