Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker |
NPI | 1003064858 |
---|---|
Provider Name | Shannon Rae Pippin |
First Address | Bradenton, FL 34208-6825 |
Second Address | Bradenton, FL 34208-6825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 29/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000471100 | (05) | FL |
006703300 | (05) | FL |