Provider Demographics
NPI:1104396035
Name:VASSAR, SHANNON DAWN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DAWN
Last Name:VASSAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WASHINGTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6295
Mailing Address - Country:US
Mailing Address - Phone:812-378-0615
Mailing Address - Fax:812-378-7989
Practice Address - Street 1:700 WASHINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6295
Practice Address - Country:US
Practice Address - Phone:812-378-0615
Practice Address - Fax:812-378-7989
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28125081A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse