Provider Demographics
NPI:1720202732
Name:REMINGTON, SHANNON M (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:REMINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:MANSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1002 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-3121
Mailing Address - Country:US
Mailing Address - Phone:641-828-7211
Mailing Address - Fax:
Practice Address - Street 1:1202 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3103
Practice Address - Country:US
Practice Address - Phone:641-828-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA001062363A00000X
IAR8200390200000X
IADO-03936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA32215OtherWELLMARK BLUE SHIELD
IAI19902Medicare PIN