Provider Demographics
NPI:1487681177
Name:SHANNON, MAUREEN T (RN NP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:T
Last Name:SHANNON
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:BABITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP
Mailing Address - Street 1:1635 DIVISADERO STREET
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA001920Medicaid
CA001920Medicaid
CAQ48762Medicare UPIN