Provider Demographics
NPI:1619194727
Name:SHANNON, SUSAN JOHNSON (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOHNSON
Last Name:SHANNON
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 1:1367 CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-9638
Mailing Address - Country:US
Mailing Address - Phone:828-627-0902
Mailing Address - Fax:
Practice Address - Street 1:157 PARAGON PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9481
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:828-452-6730
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125103163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health