Basic Information
| Provider Information | |||||||||
| NPI: | 1720202732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REMINGTON | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MANSER | ||||||||
| OtherFirstName: | SHANNON | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1002 S LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501383121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418287211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1202 W HOWARD ST | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501383103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6418287211 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | IA001062 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 390200000X | R8200 | IA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | DO-03936 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32215 | 01 | IA | WELLMARK BLUE SHIELD | OTHER |