Provider Demographics
NPI:1922715267
Name:DURR, SHANNON RENEE (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:DURR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:RENEE
Other - Last Name:STREETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:542 BANE CUT OFF ROAD
Mailing Address - Street 2:
Mailing Address - City:ELK GARDEN
Mailing Address - State:WV
Mailing Address - Zip Code:26717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 S MINERAL ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2938
Practice Address - Country:US
Practice Address - Phone:304-813-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86882163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health