Healthcare Provider Details

I. General information

NPI: 1174844211
Provider Name (Legal Business Name): SHANNON CLINARD RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 MAPLE ST
GREENSBORO NC
27405-6910
US

IV. Provider business mailing address

1800 BROOKFORD RD
KERNERSVILLE NC
27284-9460
US

V. Phone/Fax

Practice location:
  • Phone: 336-641-3896
  • Fax:
Mailing address:
  • Phone: 336-641-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number144843
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: