Shannon Louise Lis, CPNP

Primary specialty

Pediatric Registered NurseTaxonomy code 163WP0200X

License

487112 Issued in CA

Practice address

62 Port of Spain Rd
Coronado, CA 92118-3226

Phone

(619) 628-0183

NPI assigned

Dec 14, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513209600000",
    "number": "1043726995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 PORT OF SPAIN RD",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921183226",
            "telephone_number": "619-628-0183",
            "fax_number": "619-628-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 PORT OF SPAIN RD",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921183226",
            "telephone_number": "619-628-0183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIS",
        "first_name": "SHANNON",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-14",
        "last_updated": "2017-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "CA",
            "license": "487112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Laroe, LCSW
• Laura Norton Petrovich MD PC
• Lisa Marems Lazar, PHD
• Angie Lee, PHARM.D.
• Garrick Nicholas Li, PT, DPT
• Lisa M Considine DO Inc
• Craig Liu, O.D.
• Robert G Loeb, MD
• D. A. Lopez, M.D.
• Maria G Lopez, M.D

• Pediatric Registered Nurse in Coronado, CA
• Providers in Coronado, CA by specialty
• Pediatric Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.