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Individual
SHANNON MICHELLE WHITAKER
Active
Individual
SHANNON MICHELLE WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101405
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101405
MEDICAL LICENSE
NC
01
—
2743473C
MEDICARE
NC
05
—
7901897
—
NC
05
—
8901898
—
NC
01
—
970010711
RR MEDICARE
NC
Enumeration date
12/13/2005
Last updated
03/07/2023
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