Individual
MRS. SHANNON BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1382 W B AVE, PLAINWELL, MI 49080-9685
(616) 405-5992
Mailing address
1382 W B AVE, PLAINWELL, MI 49080-9685
(616) 405-5992
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
S530765069584
MI
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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