=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891594271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON ACHORN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 COMMONS DR
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04841-5544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-466-8788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 865 PINNACLE RD
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04949-3524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-542-7402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP241796
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------