Individual
SHANNON L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CCM
Contact information
Practice address
1115 W 5TH ST, TEMPE, AZ 85281-2510
(480) 929-9909
(480) 804-0384
Mailing address
1115 W 5TH ST, TEMPE, AZ 85281-2510
(480) 929-9909
(480) 804-0384
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
242334
AZ
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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