Provider Demographics
NPI:1942813548
Name:HINRICHS, SHANNA STARR (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:STARR
Last Name:HINRICHS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 LORETTA LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-7369
Mailing Address - Country:US
Mailing Address - Phone:972-839-9443
Mailing Address - Fax:214-833-3169
Practice Address - Street 1:4428 MAIN ST # 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1119
Practice Address - Country:US
Practice Address - Phone:972-839-9443
Practice Address - Fax:214-833-3169
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
TX99434176B00000X, 176B00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN