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Individual

TABITHA SHANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
8910 WESTHILL RD, LAKESIDE, CA 92040-3617
(619) 857-6864
Mailing address
PO BOX 7506, SAN DIEGO, CA 92167-0506
(619) 857-6864

Taxonomy

Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
751974
CA

Other

Enumeration date
05/13/2020
Last updated
05/13/2020
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