Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN237628 | OH |
NPI | 1003286915 |
---|---|
Provider Name | Shannon Marie Canterbury |
First Address | Toledo, OH 43606-3895 |
Second Address | Toledo, OH 43606-3895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 05/10/2015 |