MEDICARE: SHANNON FABIAN

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	163WL0100X	Lactation Consultant (Registered Nurse)	164523	CO

General Provider Information

NPI Number	:	1588409163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON FABIAN

Provider Business Mailing Address
First Line	:	2214 ANDREWS ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7102
Country	:	US
Telephone Number	:	970-999-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 ANDREWS ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7102
Country	:	US
Telephone Number	:	970-999-5755
Fax Number	:

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

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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Directions to “ SHANNON FABIAN ” Practice Location

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