Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 1480 | TX |
Y | 363LG0600X | Nurse Practitioner - Gerontology | A01383 ANP | AR |
NPI | 1043322191 |
---|---|
Provider Name | Mrs. Shannon Morgan Mayville |
First Address | Bonham, TX 75418-4059 |
Second Address | Bonham, TX 75418-4059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 01/03/2012 |