SHANNEN MARIE SEVERSEN (NPI# 1457895161) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457895161 |
| Entity Type | Individual |
| Full Name | SHANNEN MARIE SEVERSEN |
| Credential | PA-C |
| Practice Address |
3618 Lantana Road Suite 200 Lake Worth FL 33462-2247 |
| Mailing Address |
3424 Diane Dr Boynton Beach FL 33435-8554 |
| Practice Telephone | 5619682995 |
| Practice Fax Number | 5619680203 |
| Mailing Telephone | 5613719158 |
| Mailing Fax Number | 5619680203 |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2016-12-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA2306 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3618 LANTANA ROAD SUITE 200 |
| City | LAKE WORTH |
| State | FL |
| Zip Code | 33462-2247 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730150087 | Cari A Murry | Physician Assistant | 3618 Lantana Road, Suite 201, Lake Worth, FL 33462 | 2006-01-26 |
| 1811272990 | John Upegui | Physician Assistant | 3618 Lantana Road, Suite 201, Lake Worth, FL 33462 | 2011-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104449503 | Brightlife Institute, LLC | Clinic/Center | 2315 Shimmery Lane, Lake Worth, FL 33462 | 2020-05-20 |
| 1760024988 | Woodelyne Marc | Home Health | 1307 Flamingo Dr, Lantan, FL 33462 | 2019-10-09 |
| 1336624428 | Jennifer Lynn Jones | Nurse Practitioner | 5401 S Congress Ave Ste 105, Atlantis, FL 33462 | 2018-09-25 |
| 1427548445 | Publix Super Markets, Inc. | Pharmacy | 262 S Ocean Blvd, Manalapan, FL 33462 | 2018-05-15 |
| 1629567474 | Perfection Rx LLC | Pharmacy | 3248 Lantana Rd, Lake Worth, FL 33462 | 2018-05-08 |
| 1942797824 | Mayra Alejandra Tovar Castro | Student in an Organized Health Care Education/Training Program | 180 Jfk Drive, Suite 210, Atlantis, FL 33462 | 2018-04-17 |
| 1285131169 | Samar Ibrahim Mohamed Huss Aboulenain | Student in an Organized Health Care Education/Training Program | 180 Jfk Drive, Suite 210, Atlantis, FL 33462 | 2018-04-09 |
| 1801392535 | Carla Ortega | Student in an Organized Health Care Education/Training Program | 180 Jkf Drive, Suite 210, Atlantis, FL 33462 | 2018-04-02 |
| 1811427438 | Sonia Camille | Behavior Technician | 49 Sioux Ln, Lantana, FL 33462 | 2017-06-15 |
| 1922536648 | Alyzza De La Uz Forte | Nurse Practitioner | 180 John F Kennedy Dr, 311, Atlantis, FL 33462 | 2017-05-25 |
| Find all providers in zip 33462 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720635998 | Jose R Munoz | Physician Assistant | 4801 Esedra Ct Apt 203, Lake Worth, FL 33467-5019 | 2019-08-22 |
| 1194389361 | John Santoro | Physician Assistant | 10628 Paso Fino Dr, Lake Worth, FL 33449-8018 | 2019-04-23 |
| 1043536402 | On Call, Inc | Physician Assistant | 6660 Ashburn Rd, Lake Worth, FL 33467-7316 | 2010-04-10 |
| 1548273097 | Oscar J Ordenana | Physician Assistant | 1926 10th Ave N Ste 105, Lake Worth, FL 33461-3300 | 2006-08-15 |
| 1710513056 | West Palm Beach Surgical Assisting LLC | Physician Assistant | 10628 Paso Fino Dr, Lake Worth, FL 33449-8018 | 2020-03-18 |
| 1770117830 | Monica Tirtarahardja | Physician Assistant | 5503 S Congress Ave Ste 204, Lake Worth, FL 33462-6626 | 2020-02-27 |
| 1831747427 | Jose Munoz Surgical Assistant Services LLC | Physician Assistant | 4801 Esedra Ct Apt 203, Lake Worth, FL 33467-5019 | 2019-08-28 |
| 1023401023 | Heather Vangeldren Rnfa Services Inc | Physician Assistant | 7615 Woodland Creek Ln, Lake Worth, FL 33467-6522 | 2015-03-15 |
| 1659650620 | Stephanie L Ferrer | Physician Assistant | 4685 S Congress Ave, Suite 201, Lake Worth, FL 33461-4761 | 2011-08-09 |
| 1851408587 | Clare Morales | Physician Assistant | 4665 S Congress Ave, Suite 100, Lake Worth, FL 33461-4754 | 2006-08-25 |
| Find all providers in LAKE WORTH | ||||
| City | LAKE WORTH |
| Zip Code | 33462 |
Please comment or provide details below to improve the information on SHANNEN MARIE SEVERSEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.