MRS. LYNN REDDEN SHATTUCK NP NPI 1679556724

NPI Information

NPI: 1679556724
Provider Name: MRS. LYNN REDDEN SHATTUCK, NP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
2828 CONCORD ST
TRAVERSE CITY, MI
ZIP 49684
Phone: (231) 346-6930
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MRS. Lynn Redden Shattuck, NP is an adult health nurse practitioner in Traverse City, MI. MRS. Lynn Redden Shattuck, NP NPI is 1679556724. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2828 CONCORD ST
TRAVERSE CITY, MI
ZIP 49684-618
Phone: (231) 346-6930

The NPI 1679556724 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/22/2005 and was last updated on 2/22/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	102054	NORTH CAROLINA	No
2	363LA2200X	Nurse Practitioner	Adult Health	4704295437	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	P24420015	MEDICARE PIN	MICHIGAN
2	P41508	MEDICARE UPIN	NORTH CAROLINA
3	2599428A	MEDICARE ID-TYPE UNSPECIFIED	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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