Provider Demographics
NPI:1760537617
Name:GIGOUNAS, SHANNON RENEE (MSN, RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RENEE
Last Name:GIGOUNAS
Suffix:
Gender:F
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DOLORES AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5007
Mailing Address - Country:US
Mailing Address - Phone:925-330-5519
Mailing Address - Fax:
Practice Address - Street 1:201 DOLORES AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5007
Practice Address - Country:US
Practice Address - Phone:925-330-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP72583Medicare UPIN