Provider Demographics
NPI:1386408052
Name:ROBERTS, SHANNON LYNN (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LYNN
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:29803 OLD SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4770
Mailing Address - Country:US
Mailing Address - Phone:559-901-4260
Mailing Address - Fax:
Practice Address - Street 1:29803 OLD SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-4770
Practice Address - Country:US
Practice Address - Phone:559-901-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95137831163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice