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NPI Code Detail

MEDICARE: SHANNON HUDDLESTON

MEDICARE: SHANNON HUDDLESTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376K00000XNurse's Aide44985MI

General Provider Information

NPI Number : 1639637176
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON HUDDLESTON
Provider Business Mailing Address
First Line : 848 OGDEN AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5135
Country : US
Telephone Number : 269-759-4149
Fax Number :
Provider Business Practice Location Address
First Line : 1385 E EMPIRE AVE
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-2037
Country : US
Telephone Number : 269-925-0033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2019
Last Update Date : 03/04/2019

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Directions to “ SHANNON HUDDLESTON ” Practice Location

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