Provider Demographics
NPI:1093905648
Name:DEAL, SHANNON (NP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DEAL
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF TN MARTIN STUDENT HEALTH SERVICES
Mailing Address - Street 2:609 LEE STREET
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38238-0001
Mailing Address - Country:US
Mailing Address - Phone:731-881-7750
Mailing Address - Fax:731-881-7752
Practice Address - Street 1:UNIVERSITY OF TN MARTIN STUDENT HEALTH SERVICES
Practice Address - Street 2:609 LEE STREET
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38238-0001
Practice Address - Country:US
Practice Address - Phone:731-881-7750
Practice Address - Fax:731-881-7752
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN12363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily