Provider Demographics
NPI:1972005874
Name:ZAFFINO, SHANNON ELIZABETH (CNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:ZAFFINO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELIZABETH
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1502 NE MOON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-9560
Mailing Address - Country:US
Mailing Address - Phone:832-314-0082
Mailing Address - Fax:
Practice Address - Street 1:8300 CONSTITUTION AVE NE BLDG D
Practice Address - Street 2:ENDOCRINOLOGY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-559-6400
Practice Address - Fax:505-559-6488
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8E886C5C163WM0705X
WAAP61052215363LA2200X
OR201807632NP-PP363LA2200X
NM67625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07756887Medicaid