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NPI Code Detail

MEDICARE: MRS. SHANNA LYNN DRISCOLL RN, BSN

MEDICARE: MRS. SHANNA LYNN DRISCOLL RN, BSN
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
1163WC1500XCommunity Health Registered Nurse4704237602MI

General Provider Information

NPI Number : 1366916702
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNA LYNN DRISCOLL RN, BSN
Provider Business Mailing Address
First Line : 5390 HUNTSMAN DR
Second Line :
City : WHITE LAKE
State : MI
Zip : 48383-1678
Country : US
Telephone Number : 810-599-1284
Fax Number :
Provider Business Practice Location Address
First Line : 5758 COOLEY LAKE RD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-3073
Country : US
Telephone Number : 248-421-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2019
Last Update Date : 01/18/2019

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