1710296033 NPI number — MRS. SHANNON CHRISTINE MATTHEWS APRN

Table of content: MRS. SHANNON CHRISTINE MATTHEWS APRN (NPI 1710296033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710296033 NPI number — MRS. SHANNON CHRISTINE MATTHEWS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
SHANNON
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTHEWS
Provider Other First Name:
SHANNON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710296033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11824 MULLAN GULCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT REGIS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59866-9640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-338-2888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11824 MULLAN GULCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT REGIS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59866-9640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-338-2888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  527091 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: NUR-LIC-159478 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)