Provider Demographics
NPI:1104332535
Name:YAMASHIRO, SHANNON M (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:YAMASHIRO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6734
Mailing Address - Country:US
Mailing Address - Phone:661-860-7026
Mailing Address - Fax:
Practice Address - Street 1:3300 N SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6734
Practice Address - Country:US
Practice Address - Phone:661-860-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI320516164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse