Provider Demographics
NPI:1518391002
Name:BLOOD, SHANNON CRISTINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CRISTINE
Last Name:BLOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHGATE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3974
Mailing Address - Country:US
Mailing Address - Phone:541-276-1911
Mailing Address - Fax:541-278-1412
Practice Address - Street 1:1100 SOUTHGATE
Practice Address - Street 2:SUITE 2
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3974
Practice Address - Country:US
Practice Address - Phone:541-276-1911
Practice Address - Fax:541-278-1412
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR023589874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily