Provider Demographics
NPI:1104145069
Name:MCKEON, SHAUNA (APRN)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALDEN PL
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1102
Mailing Address - Country:US
Mailing Address - Phone:802-222-5201
Mailing Address - Fax:802-877-0012
Practice Address - Street 1:1 ALDEN PL
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1102
Practice Address - Country:US
Practice Address - Phone:802-222-5201
Practice Address - Fax:802-877-0012
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0108269363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104145069OtherNPI