Individual
SHANNON ISEMINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3536 FOWLER AVE, OGDEN, UT 84403-1123
(801) 643-1983
Mailing address
3536 FOWLER AVE, OGDEN, UT 84403-1123
(801) 643-1983
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
317775-4810
UT
Other
Enumeration date
04/17/2014
Last updated
04/17/2014
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