Provider Demographics
NPI:1174033104
Name:MAY, SHANNOAH LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:SHANNOAH
Middle Name:LYNN
Last Name:MAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7598 RAMBLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-7647
Mailing Address - Country:US
Mailing Address - Phone:701-739-8665
Mailing Address - Fax:
Practice Address - Street 1:123 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2313
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:509-545-8932
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002749363LF0000X
WAAP60983687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2136224Medicaid