Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | P0557 | TX |
NPI | 1003079666 |
---|---|
Provider Name | Shanna Michelle Calero |
First Address | Lafayette, LA 70508-3870 |
Second Address | El Paso, TX 79902-3320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287722711 | (05) | TX |
79922066 | (05) | NM |