MEDICARE: SHANNON C MUNRO NP

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	104100000X	Social Worker	LS7243	ME
2	363LF0000X	Family Nurse Practitioner	AP081371	ME
3	363LF0000X	Family Nurse Practitioner	R049265	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295828499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON C MUNRO NP

Provider Business Mailing Address
First Line	:	37 PALMER ST STE 3
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1341
Country	:	US
Telephone Number	:	207-454-8195
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 PALMER ST STE 3
Second Line	:
City	:	CALAIS
State	:	ME
Zip	:	04619-1341
Country	:	US
Telephone Number	:	207-454-8195
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	12/15/2021

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