MEDICARE: MS. SHANNON LEE PATT

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	164W00000X	Licensed Practical Nurse	813784	NV

General Provider Information

NPI Number	:	1528654449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON LEE PATT

Provider Business Mailing Address
First Line	:	4000 E BONANZA RD APT 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2274
Country	:	US
Telephone Number	:	702-945-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 N 13TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4156
Country	:	US
Telephone Number	:	702-384-3746
Fax Number	:	702-366-0498

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

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	12/15/2020

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