Provider Demographics
NPI:1912535204
Name:MAKAMSON, SHANNON N (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:MAKAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:N
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13315 RIVER RAPID DR
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-8817
Mailing Address - Country:US
Mailing Address - Phone:251-509-4256
Mailing Address - Fax:
Practice Address - Street 1:13251 REECE BERGERON RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-7557
Practice Address - Country:US
Practice Address - Phone:228-967-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR890002163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse