Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 25656 | CA |
NPI | 1053686907 |
---|---|
Provider Name | Mrs. Shannon Michelle Reimann |
First Address | San Bernardino, CA 92408-4133 |
Second Address | San Bernardino, CA 92408-3348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2012 |
Last Update Date | 11/03/2012 |