Individual
SHANNON WALDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSA
Contact information
Practice address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-6800
(618) 997-1187
Mailing address
4787 ALBEN BARKLEY DR, PADUCAH, KY 42001-6789
(270) 442-9461
(270) 441-0079
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
4393
KY
Other
Enumeration date
07/02/2014
Last updated
09/09/2014
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