Healthcare Provider Details

I. General information

NPI: 1548720410
Provider Name (Legal Business Name): SHANNON MARIE JARVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OCEAN ST
MARSHFIELD MA
02050
US

IV. Provider business mailing address

1880 OCEAN ST
MARSHFIELD MA
02050-4906
US

V. Phone/Fax

Practice location:
  • Phone: 617-688-3188
  • Fax:
Mailing address:
  • Phone: 781-837-5381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN253297
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN253297
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: