Provider Demographics
NPI:1730614579
Name:SHANNON, TIMOTHY PATRICK (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:SHANNON
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 15TH AVE NE APT 406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6249
Mailing Address - Country:US
Mailing Address - Phone:206-612-8666
Mailing Address - Fax:
Practice Address - Street 1:9245 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5569
Practice Address - Country:US
Practice Address - Phone:206-612-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2024-02-10
Deactivation Date:2024-02-01
Deactivation Code:
Reactivation Date:2024-02-08
Provider Licenses
StateLicense IDTaxonomies
WAPC60752642246RP1900X
WARN61217405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy