Provider Demographics
NPI:1649405960
Name:SHANNON WOUND CARE CONSULTANTS LLC
Entity Type:Organization
Organization Name:SHANNON WOUND CARE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MCVAUGH
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-355-3060
Mailing Address - Street 1:318 CONERTY RD
Mailing Address - Street 2:
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-1820
Mailing Address - Country:US
Mailing Address - Phone:724-355-3060
Mailing Address - Fax:
Practice Address - Street 1:318 CONERTY RD
Practice Address - Street 2:
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-1820
Practice Address - Country:US
Practice Address - Phone:724-355-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty