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1134954670 NPI number — MORGAN JAYE MCCARDELL SHANNON NP

NPI Number: 1134954670
Health Care Provider/Practitioner: MORGAN JAYE MCCARDELL SHANNON NP

Information about “1134954670” NPI (MORGAN JAYE MCCARDELL SHANNON NP) exists in 1134954670 in HTML format HTML  |  1134954670 in plain Text format TXT  |  1134954670 in PDF (Portable Document Format) PDF  |  1134954670 in an XML format XML  formats.

NPI Number : 1134954670 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134954670",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHANNON",
    "FirstName": "MORGAN",
    "MiddleName": "JAYE MCCARDELL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCCARDELL",
    "OtherFirstName": "MORGAN",
    "OtherMiddleName": "JAYE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2283 W BASTIEN LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COEUR D ALENE",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83815",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-377-2449",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2121 W IRONWOOD CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COEUR D ALENE",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83814-2639",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-625-4680",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/04/2024",
    "LastUpdateDate": "07/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "7361470",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207XS0106X",
          "TaxonomyName": "Orthopaedic Hand Surgery Physician",
          "LicenseNumber": "7361470",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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