Individual
TODD SHANNON WHITE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
912 1ST ST NW, ALBUQUERQUE, NM 87102-2355
(505) 224-9777
Mailing address
912 1ST ST NW, ALBUQUERQUE, NM 87102-2355
(505) 224-9777
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1144
NM
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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