Individual
SHANNON BEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1375 VISTA LN, CARSON CITY, NV 89703
(775) 882-2067
(775) 882-2254
Mailing address
1375 VISTA LN, CARSON CITY, NV 89703-4643
(775) 882-2067
(775) 882-2254
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
A97355
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/09/2005
Last updated
11/16/2019
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