Individual
SHANNON KAY DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
400 N PENNSYLVANIA AVE STE 101, ROSWELL, NM 88201-4758
(575) 623-9101
Mailing address
400 N PENNSYLVANIA AVE STE 101, ROSWELL, NM 88201-4758
(575) 623-9101
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
24391
TN
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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