MEDICARE: SHANNON L FENNIE FNP

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	363LF0000X	Family Nurse Practitioner	AP4576	AZ

General Provider Information

NPI Number	:	1932458429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON L FENNIE FNP

Provider Business Mailing Address
First Line	:	839 W CONGRESS ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2819
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:	520-309-2560

Provider Business Practice Location Address
First Line	:	1 W BROADWAY BLVD STE 151
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-3029
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:	520-309-2560

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	03/18/2025

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