Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 243295 | AZ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 243295 | AZ |
NPI | 1073141529 |
---|---|
Provider Name | Shannalee Senior |
First Address | Wickenburg, AZ 85390-2491 |
Second Address | Wickenburg, AZ 85390-2491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2020 |
Last Update Date | 29/01/2021 |