Provider Demographics
NPI:1962935999
Name:TRIPPE, SHANNON M (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:TRIPPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6665 GRANITE GATE PASS
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-2346
Mailing Address - Country:US
Mailing Address - Phone:770-688-7392
Mailing Address - Fax:770-559-8725
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4248
Practice Address - Country:US
Practice Address - Phone:770-559-8725
Practice Address - Fax:770-559-8276
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN123011163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant