Provider Demographics
NPI:1245417781
Name:SHANNON, SUSAN LAWTON (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LAWTON
Last Name:SHANNON
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 1:147 CEMETARY RD
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4179
Mailing Address - Country:US
Mailing Address - Phone:315-393-1013
Mailing Address - Fax:
Practice Address - Street 1:147 CEMETARY RD
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4179
Practice Address - Country:US
Practice Address - Phone:315-393-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138366-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse