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NPI Code Detail

MEDICARE: SHANNON ANDERSON

MEDICARE: SHANNON ANDERSON
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1386267953
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ANDERSON
Provider Business Mailing Address
First Line : 217 W GEORGIA AVE STE 120
Second Line :
City : NAMPA
State : ID
Zip : 83686-6812
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 217 W GEORGIA AVE STE 120
Second Line :
City : NAMPA
State : ID
Zip : 83686-6812
Country : US
Telephone Number : 208-498-1760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2020
Last Update Date : 05/18/2020

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Directions to “ SHANNON ANDERSON ” Practice Location

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