Individual
MRS. SHANNON MARIE MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
511 8TH ST, CLARKSVILLE, TN 37040-3093
(931) 920-7200
(931) 920-7206
Mailing address
1291 BARKLEY HILLS CIR, CLARKSVILLE, TN 37040-8103
(931) 648-1405
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
00119156
TN
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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