Provider Demographics
NPI:1023665429
Name:SITZMANN, SHANNON RHEA (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:RHEA
Last Name:SITZMANN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RHEA
Other - Last Name:HEADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 TRIMBLE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7180
Mailing Address - Country:US
Mailing Address - Phone:573-818-3067
Mailing Address - Fax:
Practice Address - Street 1:2900 TRIMBLE RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7180
Practice Address - Country:US
Practice Address - Phone:573-818-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine