Individual
SHANNON S POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3150 CARLISLE BLVD NE STE 105, ALBUQUERQUE, NM 87110-1680
(505) 633-8173
Mailing address
2620 S MILLER DR APT 202, LAKEWOOD, CO 80227-2743
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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