Healthcare Provider Details

I. General information

NPI: 1407112055
Provider Name (Legal Business Name): SHANNON TREVINO APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LENAHAN RN

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date: 08/13/2018
Reactivation Date: 08/29/2018

III. Provider practice location address

PO BOX 211699
EAGAN MN
55121-3699
US

IV. Provider business mailing address

PO BOX 211699
EAGAN MN
55121-3699
US

V. Phone/Fax

Practice location:
  • Phone: 866-849-0692
  • Fax: 888-973-8821
Mailing address:
  • Phone: 866-849-0692
  • Fax: 888-973-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number183243
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11022196
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number90726
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number343801
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0994056
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number760780
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1139739
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10026914
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: