Individual
SHANNON M HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12680 OLIVE BLVD STE 116, SAINT LOUIS, MO 63141-6322
(314) 529-5660
Mailing address
12680 OLIVE BLVD STE 116, SAINT LOUIS, MO 63141-6322
(314) 529-5660
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
041355995
IL
363LP0200X
Pediatric Nurse Practitioner
Primary
2021045875
MO
Other
Enumeration date
11/24/2014
Last updated
03/08/2024
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