Provider Demographics
NPI:1831152834
Name:EDMOND, SHANNON DAWN (ARNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:DAWN
Last Name:EDMOND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 UTICA RIDGE RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1644
Mailing Address - Country:US
Mailing Address - Phone:563-742-5750
Mailing Address - Fax:563-742-5755
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5750
Practice Address - Fax:563-742-4656
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA103775363L00000X
IAK103775363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1831152834Medicaid