Individual
MS. SHANNON MARIE JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2024 S BALDWIN UNIT 76, MESA, AZ 85209-1706
(504) 909-3872
Mailing address
11426 E PETRA AVE, MESA, AZ 85212-1964
(504) 909-3872
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN205721
AZ
363LA2100X
Acute Care Nurse Practitioner
Primary
276686
AZ
Other
Enumeration date
03/14/2022
Last updated
02/10/2024
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