Provider Demographics
NPI:1891934907
Name:CRONAN, SHANNA MARIE (RN,PHN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNA
Middle Name:MARIE
Last Name:CRONAN
Suffix:
Gender:F
Credentials:RN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 NORTHGATE DR
Mailing Address - Street 2:104
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3636
Mailing Address - Country:US
Mailing Address - Phone:415-473-7805
Mailing Address - Fax:415-473-6002
Practice Address - Street 1:899 NORTHGATE DR
Practice Address - Street 2:104
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3636
Practice Address - Country:US
Practice Address - Phone:415-473-7805
Practice Address - Fax:415-473-6002
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288992163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health