Provider Demographics
NPI:1598939860
Name:LASSEN, SHANNON D (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:LASSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 TEASLEY LN
Mailing Address - Street 2:STE 200
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4652
Mailing Address - Country:US
Mailing Address - Phone:940-382-9898
Mailing Address - Fax:940-383-3815
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005375363AM0700X
PA10005375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1060443Medicaid