Provider Demographics
NPI:1730342882
Name:RICCI, SHANNA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:MARIE
Last Name:RICCI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-1846
Mailing Address - Country:US
Mailing Address - Phone:605-622-2640
Mailing Address - Fax:
Practice Address - Street 1:1440 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1846
Practice Address - Country:US
Practice Address - Phone:605-622-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR031124163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse