Provider Demographics
NPI:1851451249
Name:RIO, SHANNON (FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CATALINA DR SUITE 5
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1624
Mailing Address - Country:US
Mailing Address - Phone:541-488-3221
Mailing Address - Fax:541-488-5884
Practice Address - Street 1:246 CATALINA DR SUITE 5
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1624
Practice Address - Country:US
Practice Address - Phone:541-488-3221
Practice Address - Fax:541-488-5884
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR085074775N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR073403Medicaid
ORR112815Medicare ID - Type Unspecified
OR073403Medicaid