Individual
SHANNON MARIE TRANTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204-4507
(248) 534-0622
Mailing address
11960 CLARK RD, DAVISBURG, MI 48350-2608
(248) 534-0622
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010267
MI
363A00000X
Physician Assistant
PA.0008525
CO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/31/2020
Last updated
06/21/2024
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