MEDICARE: RACHEL LYNN SHANNON RN

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	171M00000X	Case Manager/Care Coordinator	RN60284420	WA
2	163W00000X	Registered Nurse	RN60284420	WA

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	:	1790358307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LYNN SHANNON RN

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 24TH WAY SW STE B3
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-6033
Country	:	US
Telephone Number	:	360-742-5003
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	03/24/2026

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