Healthcare Provider Details

I. General information

NPI: 1144548074
Provider Name (Legal Business Name): SHANNON HASSAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 29 1/2 RD
GRAND JUNCTION CO
81504-5383
US

IV. Provider business mailing address

PO BOX 20000
GRAND JUNCTION CO
81502-5033
US

V. Phone/Fax

Practice location:
  • Phone: 970-248-6906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number194495
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: