Provider Demographics
NPI:1528560349
Name:LYNCH, SHANNON ALEXIS (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ALEXIS
Last Name:LYNCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:A
Other - Last Name:BRUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26594 OLD HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3843
Mailing Address - Country:US
Mailing Address - Phone:248-939-4981
Mailing Address - Fax:
Practice Address - Street 1:26594 OLD HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3843
Practice Address - Country:US
Practice Address - Phone:248-939-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244756364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care