Provider Demographics
NPI:1861719361
Name:HENAMAN-THOMPSON, SHANNON (LPN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HENAMAN-THOMPSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 360TH STREET
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461
Mailing Address - Country:US
Mailing Address - Phone:507-440-7191
Mailing Address - Fax:
Practice Address - Street 1:2959 360TH ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-8517
Practice Address - Country:US
Practice Address - Phone:507-440-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309506-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse