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Individual
SHANNON T. THOM
Active
Individual
SHANNON T. THOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200941252RN
OR
363L00000X
Nurse Practitioner
Primary
AP60081915
WA
363LF0000X
Family Nurse Practitioner
200950065NP
OR
363LF0000X
Family Nurse Practitioner
AP60081915
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619915113
CLINIC GROUP NPI
—
05
—
213342
—
OR
Enumeration date
07/01/2009
Last updated
07/24/2018
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