Provider Demographics
NPI:1639270028
Name:SHANNON, COLLEEN ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. KINCAID ST.
Mailing Address - Street 2:SKAGIT REGIONAL CLINICS
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:3823-172ND ST NE
Practice Address - Street 2:CASCADE SKAGIT HEALTH ALLIANCE
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-651-8365
Practice Address - Fax:360-651-8368
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004599363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624370Medicaid
WAAB12414Medicare ID - Type Unspecified
WA9624370Medicaid
WAS92724Medicare UPIN