Provider Demographics
NPI:1063169050
Name:FEARS, SHANNON LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEE
Last Name:FEARS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3625 W CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3198
Mailing Address - Country:US
Mailing Address - Phone:623-915-8005
Mailing Address - Fax:623-915-8102
Practice Address - Street 1:3625 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3198
Practice Address - Country:US
Practice Address - Phone:623-915-8005
Practice Address - Fax:623-915-8102
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN161897163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool