Healthcare Provider Details

I. General information

NPI: 1760114334
Provider Name (Legal Business Name): SHANNON G RESTO NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11432 NW 101ST ST
YUKON OK
73099-7463
US

IV. Provider business mailing address

11432 NW 101ST ST
YUKON OK
73099-7463
US

V. Phone/Fax

Practice location:
  • Phone: 405-501-4784
  • Fax:
Mailing address:
  • Phone: 405-501-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209617
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209617
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: