Provider Demographics
NPI:1821424276
Name:CANNON, SHANA COLE (LPN)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:COLE
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3623
Mailing Address - Country:US
Mailing Address - Phone:901-476-1820
Mailing Address - Fax:
Practice Address - Street 1:777 W. POPLAR AVE.
Practice Address - Street 2:SUITE 104
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017
Practice Address - Country:US
Practice Address - Phone:901-221-7175
Practice Address - Fax:901-221-7913
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000078550164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse