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General NPI Number Information
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NPI Number | 1215311485
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Entity Type | Individual
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Provider Name | SHANNON SMAIL L.V.N.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 5130 SIERRA ST
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City | RIVERSIDE
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State | CA
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Zip | 92504-2261
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Country | US
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Telephone | 951-903-6250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4797
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City | RIVERSIDE
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State | CA
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Zip | 92514-4797
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Country | US
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Telephone | 951-903-6250
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN 278538
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License Number State | CA
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