Provider Demographics
NPI:1548606999
Name:MCCONNELL, SHAUNA LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LYNNE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1280
Mailing Address - Country:US
Mailing Address - Phone:585-593-9410
Mailing Address - Fax:
Practice Address - Street 1:94 N. MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895
Practice Address - Country:US
Practice Address - Phone:585-593-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY587763163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse