Provider Demographics
NPI:1710296033
Name:MATTHEWS, SHANNON CHRISTINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:11824 MULLAN GULCH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT REGIS
Mailing Address - State:MT
Mailing Address - Zip Code:59866-9640
Mailing Address - Country:US
Mailing Address - Phone:702-338-2888
Mailing Address - Fax:
Practice Address - Street 1:11824 MULLAN GULCH RD
Practice Address - Street 2:
Practice Address - City:SAINT REGIS
Practice Address - State:MT
Practice Address - Zip Code:59866-9640
Practice Address - Country:US
Practice Address - Phone:702-338-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527091163W00000X
MTNUR-LIC-159478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse