Healthcare Provider Details

I. General information

NPI: 1518540079
Provider Name (Legal Business Name): AMBER SHANNON RN, BSN, CMC, HPCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/18/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21851 NEWLAND ST SPC 171
HUNTINGTON BEACH CA
92646-7632
US

IV. Provider business mailing address

21851 NEWLAND ST SPC 17
HUNTINGTON BEACH CA
92646-7624
US

V. Phone/Fax

Practice location:
  • Phone: 714-319-5606
  • Fax:
Mailing address:
  • Phone: 714-319-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number752326
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number752326
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number752326
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number752326
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number752326
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number752326
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number752326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: