Provider Demographics
NPI:1073653804
Name:ELLIOTT, SHANNON LEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LEE
Last Name:ELLIOTT
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 1:45 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3961
Mailing Address - Country:US
Mailing Address - Phone:501-650-6704
Mailing Address - Fax:
Practice Address - Street 1:4107 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2653
Practice Address - Country:US
Practice Address - Phone:501-955-2220
Practice Address - Fax:501-955-5531
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL41867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse