Provider Demographics
NPI:1609412253
Name:SHANNON, GINGER (CPSW CSSS)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:CPSW CSSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N ALAMEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2590
Mailing Address - Country:US
Mailing Address - Phone:575-523-0111
Mailing Address - Fax:
Practice Address - Street 1:400 GOLD AVE SW STE 1300
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3274
Practice Address - Country:US
Practice Address - Phone:505-738-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist