Individual
SHANNON MICHELLE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260
(575) 396-6611
Mailing address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA00343
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32951736
—
NM
Enumeration date
07/07/2005
Last updated
11/08/2018
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