Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 236427 | NY |
N | 2080P0205X | Pediatric Endocrinologist | 35.141690 | OH |
N | 2080P0205X | Pediatric Endocrinologist | MD2017-1044 | NM |
NPI | 1225111651 |
---|---|
Provider Name | Shannon Fourtner |
First Address | Batavia, NY 14020-9621 |
Second Address | Batavia, NY 14020-9621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2006 |
Last Update Date | 10/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00027224401 | UNIVERA (01) | |
000528154001 | BC/BS (01) | |
02657463 | (05) | NY |
050805000017 | FIDELIS (01) | |
1019564320001 | PA MEDICAID (01) | |
1212950 | IHA (01) | |
I33500 | (02) |