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NPI Profile for SHANNON R GREGORY in LAVEEN VILLAGE, AZ.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
School |
101YS0200X |
| NPI # | 1356589402 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 01/28/2009 | |
| Last updated | 01/28/2009 - About 17 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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SHANNON R GREGORY
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SHANNON R GREGORY