Provider Demographics
NPI:1417391269
Name:HAAS, SHANNON (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19929 RANDOLPH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8628
Mailing Address - Country:US
Mailing Address - Phone:970-270-9906
Mailing Address - Fax:
Practice Address - Street 1:19929 RANDOLPH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8628
Practice Address - Country:US
Practice Address - Phone:970-270-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0191202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse