Individual
MS. SAMANTHA LIZ SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7850 JEFFERSON ST NE, SUITE 300, ALBUQUERQUE, NM 87109-4315
(505) 884-1114
(505) 856-6320
Mailing address
7850 JEFFERSON ST NE, SUITE 300, ALBUQUERQUE, NM 87109-4315
(505) 884-1114
(505) 856-6320
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2005-0014
NM
363AM0700X
Medical Physician Assistant
PA2005-0014
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
685518
—
NM
Enumeration date
10/04/2006
Last updated
07/14/2015
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