Healthcare Provider Details

I. General information

NPI: 1184084972
Provider Name (Legal Business Name): SHANNON OLIVER I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST SUITE 102
SCOTTSDALE AZ
85258-4510
US

IV. Provider business mailing address

10250 N 92ND ST SUITE 102
SCOTTSDALE AZ
85258-4510
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-9239
  • Fax: 480-767-9224
Mailing address:
  • Phone: 480-767-9239
  • Fax: 480-767-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: