Provider Demographics
NPI:1366916702
Name:DRISCOLL, SHANNA LYNN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:LYNN
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5390 HUNTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-1678
Mailing Address - Country:US
Mailing Address - Phone:810-599-1284
Mailing Address - Fax:
Practice Address - Street 1:5758 COOLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3073
Practice Address - Country:US
Practice Address - Phone:248-421-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237602163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health