Provider Demographics
NPI:1982291209
Name:LADD, SHANNON ALICE (CNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ALICE
Last Name:LADD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-6258
Mailing Address - Country:US
Mailing Address - Phone:605-999-4158
Mailing Address - Fax:
Practice Address - Street 1:101 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-1615
Practice Address - Country:US
Practice Address - Phone:605-234-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001916363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care