Provider Demographics
NPI:1295530830
Name:SHANNON, JANICE ROBIN
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:ROBIN
Last Name:SHANNON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-1215
Mailing Address - Country:US
Mailing Address - Phone:402-217-8609
Mailing Address - Fax:
Practice Address - Street 1:1830 N 29TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1215
Practice Address - Country:US
Practice Address - Phone:402-217-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker