MEDICARE: SHANNON JOSEPH PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704311473	MI

General Provider Information

NPI Number	:	1851098214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON JOSEPH PMHNP-BC

Provider Business Mailing Address
First Line	:	221 W LAKE LANSING RD STE 100
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8661
Country	:	US
Telephone Number	:	517-798-1167
Fax Number	:	833-740-3674

Provider Business Practice Location Address
First Line	:	221 W LAKE LANSING RD STE 100
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8661
Country	:	US
Telephone Number	:	517-798-1167
Fax Number	:	833-740-3674

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

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/03/2026

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