Individual
SHANNON ELAN BISHOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 E CONGRESS AVE, COOLIDGE, AZ 85128-4519
(520) 560-1545
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1783777
AZ
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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