Individual
MRS. SHANNA M EARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
01470
WV
363A00000X
Physician Assistant
Primary
50.002614RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0098446
—
OH
05
—
010081785
—
VA
Enumeration date
05/20/2006
Last updated
11/02/2016
Update your record
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