Individual
JUSTIN R SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2175 ROSALINE AVE, REDDING, CA 96001-2509
(530) 225-6000
(818) 587-2493
Mailing address
2100 POWELL ST, STE 900, EMERYVILLE, CA 94608-1844
(510) 851-7423
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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