Provider Demographics
NPI:1841225455
Name:HARRIS, SHANNA TOMIKO (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:TOMIKO
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:SHANNA
Other - Middle Name:TOMIKO
Other - Last Name:KREITINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-8959
Mailing Address - Fax:757-668-9848
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-8959
Practice Address - Fax:757-668-9848
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166858363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010254426Medicaid
VA10007294NOtherOPTIMA HEALTH