Individual
SHANNON KAY MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2288 MERRITT CREEK LOOP, COEUR D'ALENE, ID 83814
(208) 665-7546
(208) 667-4607
Mailing address
2288 MERRITT CREEK LOOP, COEUR D'ALENE, ID 83814
(208) 665-7546
(208) 667-4607
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
N-31561
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806523200
—
ID
Enumeration date
10/02/2006
Last updated
02/05/2009
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