Healthcare Provider Details

I. General information

NPI: 1912542556
Provider Name (Legal Business Name): SHANNON VOIGT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 BUFFUM ST
LYNN MA
01902-3965
US

IV. Provider business mailing address

8 RAMSDELL PL
LYNN MA
01904-2725
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-6528
  • Fax:
Mailing address:
  • Phone: 339-440-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2273642
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: