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General NPI Number Information
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NPI Number | 1134954670
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Entity Type | Individual
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Provider Name | MORGAN JAYE MCCARDELL SHANNON NP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 2121 W IRONWOOD CENTER DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2639
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Country | US
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Telephone | 208-625-4680
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Fax |
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Provider Business Mailing Address
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Address Line | 2283 W BASTIEN LOOP
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City | COEUR D ALENE
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State | ID
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Zip | 83815
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Country | US
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Telephone | 805-377-2449
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 7361470
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 7361470
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License Number State | ID
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