Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | SD008957 | MI |
NPI | 1316961196 |
---|---|
Provider Name | Dr. Shannon K Roznay |
First Address | Saline, MI 48176-8930 |
Second Address | Saline, MI 48176-8930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 07/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99701 | (02) | MI |