Individual
DR. SHANNON RENEE BLACKMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
NMRTC, DIRECTORATE OF PUBLIC HEALTH SERVICES, 620 JOHN PAUL JONES CIRCLE, PORTSMOUTH, VA 23708
(757) 953-0613
Mailing address
109 TUCKER DR, SUFFOLK, VA 23435-3573
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
0101250670
VA
208D00000X
General Practice Physician
A97553
CA
Other
Enumeration date
11/20/2006
Last updated
10/06/2021
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