Provider Demographics
NPI:1154338440
Name:WINN, SHANNON COLE (CPO)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:COLE
Last Name:WINN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 S IDAHO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85219-6496
Mailing Address - Country:US
Mailing Address - Phone:480-982-3000
Mailing Address - Fax:480-982-3103
Practice Address - Street 1:1075 S IDAHO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-6496
Practice Address - Country:US
Practice Address - Phone:480-982-3000
Practice Address - Fax:480-982-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCPO026521744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5813300001Medicare NSC