Provider Demographics
NPI:1730994799
Name:STUTZMAN, SHANNON S
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:S
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 32ND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3827
Mailing Address - Country:US
Mailing Address - Phone:402-562-6463
Mailing Address - Fax:402-562-6463
Practice Address - Street 1:2721 32ND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3827
Practice Address - Country:US
Practice Address - Phone:402-562-6463
Practice Address - Fax:402-562-6463
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEFII7036208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty