Individual
SHANNON WHITLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
830 AINSWORTH DR, PRESCOTT, AZ 86301-1630
(928) 777-5800
(928) 776-0405
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110002157
VA
363AM0700X
Medical Physician Assistant
Primary
10942
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173121
—
AZ
Enumeration date
11/21/2006
Last updated
04/24/2025
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