Provider Demographics
NPI:1851665038
Name:ENGLAND, SHANNON (APRN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 STONEMILL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5542
Mailing Address - Country:US
Mailing Address - Phone:270-272-2751
Mailing Address - Fax:
Practice Address - Street 1:13802 LAKE POINT CIR
Practice Address - Street 2:#102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4219
Practice Address - Country:US
Practice Address - Phone:502-245-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40543207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology