Individual
SHANIA RAE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 W CHESTNUT ST, BLOOMINGTON, IL 61701-2814
(309) 557-1400
Mailing address
448 WYLIE DR, NORMAL, IL 61761-5405
(888) 924-3786
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020018386
IL
Other
Enumeration date
09/27/2024
Last updated
09/27/2024
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