Provider Demographics
NPI:1407578057
Name:OWEN, SHANNON MARIE (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:OWEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:EASTERDAY KINYON & ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN & RN
Mailing Address - Street 1:260 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6242
Mailing Address - Country:US
Mailing Address - Phone:208-732-0959
Mailing Address - Fax:208-732-7480
Practice Address - Street 1:260 2ND AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6242
Practice Address - Country:US
Practice Address - Phone:208-732-0959
Practice Address - Fax:208-732-7480
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-33195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse