Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Customized Equipment |
332BC3200X | 87 | All Other Suppliers |
| NPI Number | 1104423714 |
| LBN Legal business name | SHANNON NICOLE BEAUTY |
| Authorized official | SHANNON PARKER - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/06/2020 |
| Last updated | 10/05/2021 - About 5 years ago |
| Identifiers | n/a |
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