MEDICARE: SHANNON VAN BRUNT RN

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	95039594	CA

General Provider Information

NPI Number	:	1871449736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON VAN BRUNT RN

Provider Business Mailing Address
First Line	:	500 DARLINGTON WAY
Second Line	:
City	:	LINCOLN
State	:	CA
Zip	:	95648-2923
Country	:	US
Telephone Number	:	408-688-1075
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 DARLINGTON WAY
Second Line	:
City	:	LINCOLN
State	:	CA
Zip	:	95648-2923
Country	:	US
Telephone Number	:	408-688-1075
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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