Individual
SHONNA BANGEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1112 S VIVIAN ST, CRANE, TX 79731-3719
(580) 301-4649
Mailing address
1112 S VIVIAN ST, CRANE, TX 79731-3719
(580) 301-4649
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47-4555495
PRIVATE PAY
TX
Enumeration date
07/21/2015
Last updated
07/21/2015
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