Individual
MISS SHANNON MARIE BEAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 JOHN R ST, DETROIT, MI 48201-2013
(313) 576-9213
Mailing address
16721 PHILOMENE BLVD, ALLEN PARK, MI 48101-2419
(313) 289-1478
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704274132
MI
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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