Individual
MRS. SHANNON NUNLIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
641PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000061551
BLUE CROSS OF MONTANA
MT
05
—
3402091
—
MT
01
—
P00434173
RAILROAD MEDICARE
MT
Enumeration date
12/29/2006
Last updated
06/01/2020
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