Provider Demographics
NPI:1841668936
Name:GIFFORD, SHANNON (LPN)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BROOKHILL DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1301
Mailing Address - Country:US
Mailing Address - Phone:302-454-3020
Mailing Address - Fax:302-709-5264
Practice Address - Street 1:24 BROOKHILL DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1301
Practice Address - Country:US
Practice Address - Phone:302-454-3020
Practice Address - Fax:302-709-5264
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0012379164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse