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General NPI Number Information
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NPI Number | 1477226975
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Entity Type | Individual
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Provider Name | SHANNEN ELAINE PLASTER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 215 GILBERT ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-3305
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Country | US
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Telephone | 540-961-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 5181 CRUMPACKER DR
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City | ROANOKE
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State | VA
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Zip | 24019-6055
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Country | US
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Telephone | 336-409-1357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024181622
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License Number State | VA
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