Provider Demographics
NPI:1104435304
Name:LINVILLE, SHANNON T
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:T
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:SOPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:25921-1686
Mailing Address - Country:US
Mailing Address - Phone:304-237-6807
Mailing Address - Fax:
Practice Address - Street 1:304 W. RAILROAD AVE.
Practice Address - Street 2:APT.2
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921
Practice Address - Country:US
Practice Address - Phone:304-237-6807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant