Provider Demographics
NPI:1841791902
Name:RYAN, SHANNON L (LAC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:843 NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2739
Mailing Address - Country:US
Mailing Address - Phone:785-371-1141
Mailing Address - Fax:785-246-5809
Practice Address - Street 1:843 NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2739
Practice Address - Country:US
Practice Address - Phone:785-371-1141
Practice Address - Fax:785-246-5809
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2300013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist