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NPI Code Detail

MEDICARE: MRS. SHANNON JEANETTE CANNON C.P.N.P.

MEDICARE:  MRS. SHANNON JEANETTE CANNON  C.P.N.P.
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
1163W00000XRegistered Nurse0001191706VA
2363LP0200XPediatric Nurse Practitioner0024167941VA

General Provider Information

NPI Number : 1811294614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON JEANETTE CANNON C.P.N.P.
Provider Business Mailing Address
First Line : 5207 HICKORY PARK DR
Second Line : SUITE C
City : GLEN ALLEN
State : VA
Zip : 23059-2624
Country : US
Telephone Number : 804-377-8981
Fax Number : 804-377-8984
Provider Business Practice Location Address
First Line : 5207 HICKORY PARK DR
Second Line : SUITE C
City : GLEN ALLEN
State : VA
Zip : 23059-2624
Country : US
Telephone Number : 804-377-8981
Fax Number : 804-377-8984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2011
Last Update Date : 12/08/2015

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Directions to “ MRS. SHANNON JEANETTE CANNON C.P.N.P.” Practice Location

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