Healthcare Provider Details

I. General information

NPI: 1962819698
Provider Name (Legal Business Name): SHANNON RISKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 09/23/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 JOHNSON RD SUITE 10
WASHINGTON PA
15301-8944
US

IV. Provider business mailing address

470 JOHNSON RD SUITE 10
WASHINGTON PA
15301-8944
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-3816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP013945
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: