Individual
SHANNON MACLEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-1110
(253) 968-1110
Mailing address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5522
(505) 853-7992
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
DR.0051993
CO
Other
Enumeration date
08/15/2008
Last updated
03/29/2021
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