Individual
MRS. SHANNON LOUISE LIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
62 PORT OF SPAIN RD, CORONADO, CA 92118-3226
(619) 628-0183
Mailing address
62 PORT OF SPAIN RD, CORONADO, CA 92118-3226
(619) 628-0183
(619) 628-0183
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
487112
CA
Other
Enumeration date
12/14/2017
Last updated
12/14/2017
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