Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | PRO167 | FL |
NPI | 1033719208 |
---|---|
Provider Name | Mrs. Shanon Imena Hardin |
First Address | Greenacres, FL 33415-1528 |
Second Address | Danville, IL 61832-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 27/10/2020 |