MEDICARE: MRS. SHANNON DEE SEGERSTROM HHC, FNMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1144171794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON DEE SEGERSTROM HHC, FNMS

Provider Business Mailing Address
First Line	:	1840 NE YELLOWSTONE LN
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6580
Country	:	US
Telephone Number	:	541-419-9699
Fax Number	:

Provider Business Practice Location Address
First Line	:	1279 NE 2ND ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4343
Country	:	US
Telephone Number	:	541-419-9699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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