Basic Information
| Provider Information | |||||||||
| NPI: | 1912187568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOZNICK | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W MAPLE AVE STE 503 | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727645376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797513722 | ||||||||
| FaxNumber: | 4797511099 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 W MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727645335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797515711 | ||||||||
| FaxNumber: | 4797511099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 219596 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2104400 | 01 | PA | HIGHMARK | OTHER | 3713583000 | 01 | PA | IBC | OTHER | 11971038 | 01 | PA | CAQH | OTHER | 1585281 | 01 | PA | GATEWAY | OTHER | 50085971 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 127186 | 01 | PA | GEISINGER | OTHER | 9720452 | 01 | PA | AETNA | OTHER | 1020670570002 | 05 | PA | MEDICAID | 2104400 | 01 | PA | FIRST PRIORITY | OTHER |