Individual
SHANNA NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM,PWS
Contact information
Practice address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 256-4635
Mailing address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 256-4635
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000107728
TRADITIONAL HEALTHCARE WORKER
OR
Enumeration date
12/22/2022
Last updated
12/22/2022
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