Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 016521 | ME |
NPI | 1023016789 |
---|---|
Provider Name | Shannon Carr |
First Address | Waterville, ME 04901-6559 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 03/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
416350099 | (05) | ME |
I22321 | (02) | ME |