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General NPI Number Information
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NPI Number | 1912422874
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Entity Type | Individual
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Provider Name | SHANNON DENHAM NGUY CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 18109 PRINCE PHILIP DR STE 300
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City | OLNEY
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State | MD
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Zip | 20832
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Country | US
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Telephone | 301-570-8554
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Fax |
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Provider Business Mailing Address
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Address Line | 14 CALYPSO CT
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City | GAITHERSBURG
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State | MD
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Zip | 20879-1584
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Country | US
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Telephone |
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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 | R200964
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License Number State | MD
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