Individual
SHANNON JO BARTLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.001961
OH
363A00000X
Physician Assistant
50001961
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00115908
RAILROAD MEDICARE PIN
OH
Enumeration date
04/12/2006
Last updated
10/18/2011
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