Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | AP60974977 | WA |
NPI | 1083158430 |
---|---|
Provider Name | Kallin Shannon |
First Address | Denver, CO 80206-2045 |
Second Address | Aurora, CO 80045-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 02/03/2020 |