Healthcare Provider Details

I. General information

NPI: 1326317660
Provider Name (Legal Business Name): SHANNON L GARRISON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON L HEDRICK

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
WARRENTON VA
20186-3027
US

IV. Provider business mailing address

69 S SERVICE RD SUITE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 540-316-5730
  • Fax: 540-316-5701
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024169896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: