=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336060128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON CLARE PIRICH CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2026
-----------------------------------------------------
Last Update Date | 07/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 N RAILROAD ST
-----------------------------------------------------
City | TAMAQUA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18252-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-645-1540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 BROOKFIELD CIR
-----------------------------------------------------
City | MACUNGIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18062-1152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-664-0149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | SP036633
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------