Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision |
NPI | 1568928380 |
---|---|
Provider Name | Shannon Alyse Crumpton |
First Address | Blue Springs, MO 64014-2755 |
Second Address | Kansas City, MO 64132-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2019 |
Last Update Date | 17/02/2019 |