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Individual

SHANNON LYONS BOFFELI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
107 E OAK AVE, FLAGSTAFF, AZ 86001-1818
(928) 779-7880
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
291176
AZ
363L00000X
Nurse Practitioner
374115-4408
UT
363L00000X
Nurse Practitioner
APRN002370
NV

Other

Enumeration date
10/13/2006
Last updated
08/22/2023
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