Individual
SHANNON SHONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2.5 MILES SW BLUE GAP STORE, BLUE GAP, AZ 86520
(505) 507-9178
(928) 725-3157
Mailing address
PO BOX 4260, BLUE GAP, AZ 86520-4260
(505) 507-9178
(928) 725-3157
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010738
—
AZ
Enumeration date
02/07/2017
Last updated
02/07/2017
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