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Individual
SHANNON EVANS
Active
Individual
SHANNON EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100592
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100592
STATE LICENSE NC
NC
Enumeration date
10/27/2006
Last updated
07/09/2007
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