1619182078 NPI number — MRS. SHANNON HILL SHELLEY C.N.M.

Table of content: MRS. SHANNON HILL SHELLEY C.N.M. (NPI 1619182078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619182078 NPI number — MRS. SHANNON HILL SHELLEY C.N.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELLEY
Provider First Name:
SHANNON
Provider Middle Name:
HILL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.N.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIRODE
Provider Other First Name:
SHANNON
Provider Other Middle Name:
HILL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619182078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 19TH STREET
Provider Second Line Business Mailing Address:
SUITE 509
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916-1853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-524-3208
Provider Business Mailing Address Fax Number:
865-522-4322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 19TH STREET
Provider Second Line Business Practice Location Address:
SUITE 509
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-524-3208
Provider Business Practice Location Address Fax Number:
865-522-4322
Provider Enumeration Date:
05/11/2007

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: 367A00000X , with the licence number:  11574 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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