MEDICARE: SHANNON BETH GERBER RN, MSN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP3672	AZ
2	363LA2200X	Adult Health Nurse Practitioner	990039	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407176480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BETH GERBER RN, MSN, NP-C

Provider Business Mailing Address
First Line	:	4570 HAGERWOOD ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7535
Country	:	US
Telephone Number	:	928-853-3123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1918 CREST HAVEN CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2901
Country	:	US
Telephone Number	:	719-761-0397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2010
Last Update Date	:	05/31/2013

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