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Individual

SHANNON R WIANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5430 W GLENN DR, GLENDALE, AZ 85301-2628
(623) 238-9763
(623) 937-5425
Mailing address
5430 W GLENN DR, GLENDALE, AZ 85301
(623) 238-9763
(623) 937-5425

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4340
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4340
AZ
Enumeration date
04/14/2009
Last updated
04/14/2009
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