Provider Demographics
NPI:1043957673
Name:WORK, SHANNON (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:WORK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0368
Mailing Address - Country:US
Mailing Address - Phone:501-776-0691
Mailing Address - Fax:501-776-0692
Practice Address - Street 1:403 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3711
Practice Address - Country:US
Practice Address - Phone:501-776-0691
Practice Address - Fax:501-776-0692
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL040218164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse