Provider Demographics
NPI:1346754694
Name:SALVESON, SHANNON ADELE (ACNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ADELE
Last Name:SALVESON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ADELE
Other - Last Name:YOUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2069 GLASTONBURY RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3546
Mailing Address - Country:US
Mailing Address - Phone:805-300-9647
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 365
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-825-0527
Practice Address - Fax:310-206-4930
Is Sole Proprietor?:No
Enumeration Date:2017-11-23
Last Update Date:2017-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007078363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care