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Individual

MRS. AMANDA GAIL SHANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
#8 MEDICAL PLAZA, HEALTH RESOURCES OF ARKANSAS, MOUNTAIN HOME, AR 72653
(870) 425-6901
(870) 424-0903
Mailing address
PO BOX 2578, HEALTH RESOURCES OF ARKANSAS, BATESVILLE, AR 72503-2578
(870) 793-8900
(870) 793-8959

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPT-002955
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LTP-002955
LPN
AR
Enumeration date
04/23/2009
Last updated
04/23/2009
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