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Individual
AMY SHANNON
Active
Individual
AMY SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
001745
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004197720
—
CT
Enumeration date
02/14/2006
Last updated
01/13/2012
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