Individual
SHANNON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNC
Contact information
Practice address
1021 WINGATE DR, FORT WAYNE, IN 46845-1351
(260) 602-3962
Mailing address
1021 WINGATE DR, FORT WAYNE, IN 46845-1351
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
06/12/2025
Last updated
06/12/2025
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