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General NPI Number Information
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NPI Number | 1689093395
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Entity Type | Individual
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Provider Name | SHANNON MCCONNAUGHEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 3525 E LOUISE DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6302
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Country | US
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Telephone | 256-468-8178
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 E LOUISE DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6302
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Country | US
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Telephone | 208-322-1680
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | M-15691
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD60683655
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License Number State | WA
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