Provider Demographics
NPI:1447542642
Name:CHRISTOPHER, SHANNON COLETTE (NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:COLETTE
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 SUMMIT BLVD
Mailing Address - Street 2:UNIT 201
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8298
Mailing Address - Country:US
Mailing Address - Phone:303-673-9090
Mailing Address - Fax:
Practice Address - Street 1:433 SUMMIT BLVD
Practice Address - Street 2:UNIT 201
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8298
Practice Address - Country:US
Practice Address - Phone:303-673-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP 990371363LF0000X, 363LF0000X, 363LF0000X
CO0990371-NP163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000144489Medicaid
CO563690ZYX6Medicare PIN
CAFHC70477FMedicaid