Healthcare Provider Details

I. General information

NPI: 1891989307
Provider Name (Legal Business Name): SHANNON C DUNN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US HWY 491 NORTH
SHIPROCK NM
87420
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-368-6401
  • Fax: 505-368-6431
Mailing address:
  • Phone: 505-368-6401
  • Fax: 505-368-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number037263
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number037263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: