Provider Demographics
NPI:1760114334
Name:RESTO, SHANNON G (NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:G
Last Name:RESTO
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 COTTONWOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-9710
Mailing Address - Country:US
Mailing Address - Phone:405-501-4784
Mailing Address - Fax:
Practice Address - Street 1:1076 COTTONWOOD LAKE DR
Practice Address - Street 2:
Practice Address - City:DIVIDE
Practice Address - State:CO
Practice Address - Zip Code:80814-9710
Practice Address - Country:US
Practice Address - Phone:405-501-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1633829163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care