Individual
MS. SHANNON L. CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA3911
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA3911
MA PA LICENSE
MA
Enumeration date
12/03/2009
Last updated
05/18/2016
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