Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2018041867 | MO |
NPI | 1265901904 |
---|---|
Provider Name | Mrs. Anna Michelle Shinneman |
First Address | Pontoon Beach, IL 62040-6480 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2018 |
Last Update Date | 18/11/2020 |