Individual
SHANNON DUVERNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4090 BRIARGATE PKWY, COLORADO SPRINGS, CO 80920-7815
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125.067151
IL
208000000X
Pediatrics Physician
69343-21
WI
208M00000X
Hospitalist Physician
Primary
DR.0068984
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265813562
—
WI
Enumeration date
06/11/2015
Last updated
11/29/2022
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