Healthcare Provider Details

I. General information

NPI: 1912816794
Provider Name (Legal Business Name): SHANNON LAUKO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WAKE FOREST RD UNIT 119
RALEIGH NC
27609-7317
US

IV. Provider business mailing address

2821 WILSHIRE HILL DR UNIT 119
RALEIGH NC
27604-5304
US

V. Phone/Fax

Practice location:
  • Phone: 315-484-8225
  • Fax:
Mailing address:
  • Phone: 315-484-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number337316
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: