Individual
RYAN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1722 PINE ST STE 700, MONTGOMERY, AL 36106-1125
(334) 834-1300
(334) 834-8347
Mailing address
PO BOX 242848, MONTGOMERY, AL 36124-2848
(334) 270-9914
(334) 270-3195
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
1-159336
AL
363LG0600X
Gerontology Nurse Practitioner
Primary
1-159336
AL
363LP2300X
Primary Care Nurse Practitioner
1-159336
AL
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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