Healthcare Provider Details

I. General information

NPI: 1225329279
Provider Name (Legal Business Name): SHANNON J TITUS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PARKS ST
MANCHESTER TN
37355-2482
US

IV. Provider business mailing address

250 SHANTUS LN
LYNCHBURG TN
37352-7454
US

V. Phone/Fax

Practice location:
  • Phone: 931-723-5134
  • Fax: 931-723-5148
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0000111414
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: