Individual
SHANNON CHRISTINE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD FACOG
Contact information
Practice address
555 E BROADWAY AVE, STE 108, JACKSON, WY 83001-8640
(307) 734-1005
(307) 734-1165
Mailing address
PO BOX 1844, JACKSON, WY 83001-1844
(307) 734-1005
(307) 734-1165
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
6698A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117467300
—
WY
Enumeration date
05/17/2006
Last updated
12/13/2012
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