Individual
SHANNAN ROTRUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
480 CENTRAL AVE, PEARL HARBOR, HI 96860-4908
(808) 474-4242
Mailing address
3 BAYSHORE CT, GAITHERSBURG, MD 20878-1979
(850) 449-9228
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704244122
MI
Other
Enumeration date
01/08/2014
Last updated
11/02/2022
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