Provider Demographics
NPI:1326141565
Name:DUCLOS, SHANNON LEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEE
Last Name:DUCLOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03263-3213
Mailing Address - Country:US
Mailing Address - Phone:603-759-9127
Mailing Address - Fax:
Practice Address - Street 1:188 ROUTE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5420
Practice Address - Country:US
Practice Address - Phone:603-314-4700
Practice Address - Fax:603-314-4711
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0476212303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily