Individual
ELIZABETH SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 240-7356
Mailing address
935 FOXHUNT LN, FAYETTEVILLE, NC 28314-6077
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA058736
PA
Other
Enumeration date
06/07/2017
Last updated
01/29/2022
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