Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053464404 |
---|---|
Provider Name | Shannon Hedstrom Barnes |
First Address | Billings, MT 59107-5100 |
Second Address | Billings, MT 59101-0909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 10/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0551072 | (05) | MT |