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Individual

SHANNAN RAE DAHL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, MT

Contact information

Practice address
13801 BRADDOCK SPRINGS RD APT K, CENTREVILLE, VA 20121-4245
(703) 853-3351
Mailing address
PO BOX 893, GAINESVILLE, VA 20156-0893
(703) 853-3351

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
0001298714
VA
225700000X
Massage Therapist
0019011674
VA

Other

Enumeration date
12/31/2021
Last updated
12/31/2021
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