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General NPI Number Information
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NPI Number | 1538830898
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Entity Type | Individual
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Provider Name | SHANNON RENAE BASSETT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2021
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 1212 PLEASANT ST STE 405
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City | DES MOINES
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State | IA
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Zip | 50309-1413
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Country | US
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Telephone | 515-241-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 522 NE STONERIDGE DR
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City | ANKENY
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State | IA
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Zip | 50021-4116
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Country | US
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Telephone | 515-447-3114
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A160964
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | A160964
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License Number State | IA
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