Provider Demographics
NPI:1346974292
Name:HARRIS, SHANNON RENEE (LVN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 NORTHROP DR APT 219
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5011
Mailing Address - Country:US
Mailing Address - Phone:951-616-7734
Mailing Address - Fax:
Practice Address - Street 1:7450 NORTHROP DR APT 219
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5011
Practice Address - Country:US
Practice Address - Phone:951-616-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN716422164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse