MEDICARE: MS. MARY ANN SHANNON

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	207X00000X	Orthopaedic Surgery Physician	D60887	NV

General Provider Information

NPI Number	:	1679562425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ANN SHANNON

Provider Business Mailing Address
First Line	:	501 S RANCHO DR
Second Line	:	SUITE I67
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4828
Country	:	US
Telephone Number	:	702-243-4700
Fax Number	:	702-243-7074

Provider Business Practice Location Address
First Line	:	501 S RANCHO DR
Second Line	:	SUITE I-67
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4828
Country	:	US
Telephone Number	:	702-243-4700
Fax Number	:	702-243-7074

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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