Provider Demographics
NPI:1285134296
Name:BURNS, SHANNON (LVN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 YOSEMITE TRL
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-7034
Mailing Address - Country:US
Mailing Address - Phone:512-621-2442
Mailing Address - Fax:
Practice Address - Street 1:901 YOSEMITE TRL
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-7034
Practice Address - Country:US
Practice Address - Phone:512-621-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314569164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse