Provider Demographics
NPI:1811294614
Name:CANNON, SHANNON JEANETTE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:JEANETTE
Last Name:CANNON
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:5207 HICKORY PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2624
Mailing Address - Country:US
Mailing Address - Phone:804-377-8981
Mailing Address - Fax:804-377-8984
Practice Address - Street 1:5207 HICKORY PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2624
Practice Address - Country:US
Practice Address - Phone:804-377-8981
Practice Address - Fax:804-377-8984
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2015-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001191706163W00000X
VA0024167941363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse