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Individual
JUSTIN R SHANNON
Active
Individual
JUSTIN R SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
PA15715
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00249929
RAILROAD MEDICARE
CA
05
—
RN559900
—
CA
Enumeration date
07/03/2006
Last updated
10/18/2017
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