MEDICARE: SHANNON RAE MUNDEE APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	896097	NV

General Provider Information

NPI Number	:	1366306607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON RAE MUNDEE APRN-CNP

Provider Business Mailing Address
First Line	:	5618 SUMMER SPLASH CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2174
Country	:	US
Telephone Number	:	702-290-2295
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 CAMINO AL NORTE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2445
Country	:	US
Telephone Number	:	702-750-2438
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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