1457912834 NPI number — SHANNON LYN POSS PA-C

Table of content: SHANNON LYN POSS PA-C (NPI 1457912834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457912834 NPI number — SHANNON LYN POSS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POSS
Provider First Name:
SHANNON
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNAMARA
Provider Other First Name:
SHANNON
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457912834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 BORMET DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOKENA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60448-8399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-346-4044
Provider Business Mailing Address Fax Number:
708-346-3287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ROCKY MOUNTAIN AVE STE 360
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538-9004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-221-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2019

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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