Healthcare Provider Details

I. General information

NPI: 1235269697
Provider Name (Legal Business Name): MS. SHANNON E WINEGARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CENTRAL PARK DR STE 101
STEAMBOAT SPRINGS CO
80482
US

IV. Provider business mailing address

940 CENTRAL PARK DR STE 101
STEAMBOAT SPRINGS CO
80482
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-1632
  • Fax: 970-879-6774
Mailing address:
  • Phone: 970-879-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number164379
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: