Provider Demographics
NPI:1679373997
Name:KAWAGUCHI, SHANNON J
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:KAWAGUCHI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:J
Other - Last Name:HOFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69363-1327
Mailing Address - Country:US
Mailing Address - Phone:308-632-8016
Mailing Address - Fax:
Practice Address - Street 1:1525 AVENUE P
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4134
Practice Address - Country:US
Practice Address - Phone:308-632-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant