Provider Demographics
NPI:1780175356
Name:ENOCHS, SHANNON (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:ENOCHS
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1100 FLYNN RD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8741
Mailing Address - Country:US
Mailing Address - Phone:805-229-1288
Mailing Address - Fax:
Practice Address - Street 1:1100 FLYNN RD UNIT 201
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8741
Practice Address - Country:US
Practice Address - Phone:805-229-1288
Practice Address - Fax:805-618-2898
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health