Provider Demographics
NPI:1609491133
Name:SHANAHAN, REBECCA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3489 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-9606
Mailing Address - Country:US
Mailing Address - Phone:616-847-7984
Mailing Address - Fax:
Practice Address - Street 1:3489 W RIVER RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-9606
Practice Address - Country:US
Practice Address - Phone:616-847-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL107070163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant