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General NPI Number Information
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NPI Number | 1093905648
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Entity Type | Individual
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Provider Name | SHANNON DEAL NP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF TN MARTIN STUDENT HEALTH SERVICES 609 LEE STREET
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City | MARTIN
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State | TN
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Zip | 38238-0001
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Country | US
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Telephone | 731-881-7750
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Fax | 731-881-7752
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Provider Business Mailing Address
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Address Line | UNIVERSITY OF TN MARTIN STUDENT HEALTH SERVICES 609 LEE STREET
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City | MARTIN
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State | TN
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Zip | 38238-0001
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Country | US
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Telephone | 731-881-7750
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Fax | 731-881-7752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12363
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License Number State | TN
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