Provider Demographics
NPI:1295949261
Name:CALLAHAN, SHANNON COLLEEN (RN)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:COLLEEN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SIRSTAD ST
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7230
Mailing Address - Country:US
Mailing Address - Phone:907-747-5397
Mailing Address - Fax:
Practice Address - Street 1:711 SIRSTAD ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7230
Practice Address - Country:US
Practice Address - Phone:907-747-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK21231163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse