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General NPI Number Information
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NPI Number | 1942868989
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Entity Type | Individual
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Provider Name | HOLLY JACOBSEN SHANNON PMHNP, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 05/11/2025
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Provider Practice Location Address
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Address Line | 450 E ROMIE LN
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City | SALINAS
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State | CA
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Zip | 93901-4029
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Country | US
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Telephone | 831-755-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 22563 INDIAN SPRINGS RD
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City | SALINAS
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State | CA
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Zip | 93908-9685
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Country | US
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Telephone | 831-521-7106
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95034882
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-23443
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License Number State | CA
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