Provider Demographics
NPI:1760280184
Name:POLLOCK, SHANNON MEGAN (LPN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MEGAN
Last Name:POLLOCK
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12428 AQUEDUCT DR E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-3636
Mailing Address - Country:US
Mailing Address - Phone:253-370-2869
Mailing Address - Fax:
Practice Address - Street 1:7224 PACIFIC HWY E
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9654
Practice Address - Country:US
Practice Address - Phone:253-205-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00042009164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse