Healthcare Provider Details

I. General information

NPI: 1215743935
Provider Name (Legal Business Name): SHANNA ALICIA DAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 PROFESSIONAL CIR STE 101
RENO NV
89521-4802
US

IV. Provider business mailing address

10315 PROFESSIONAL CIR STE 101
RENO NV
89521-4802
US

V. Phone/Fax

Practice location:
  • Phone: 775-378-5822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN75815
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: