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General NPI Number Information
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NPI Number | 1922553908
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Entity Type | Individual
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Provider Name | SHANNON D STADELMANN FNP
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Gender | Female
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 477 N EL CAMINO REAL SUITE 208A
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City | ENCINITAS
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State | CA
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Zip | 92024-1328
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Country | US
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Telephone | 760-479-3900
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Fax | 760-634-4845
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD MAIL DROP 4S-205
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 760-479-3900
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Fax | 760-634-4845
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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 | 95004762
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License Number State | CA
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