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General NPI Number Information
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NPI Number | 1992421622
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Entity Type | Organization
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Legal Business Name | SHANNAN SOUZA APRN LLC
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 5150A SR 247
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City | POTTSVILLE
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State | AR
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Zip | 72858-6002
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Country | US
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Telephone | 479-567-5680
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Fax | 479-567-5679
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Provider Business Mailing Address
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Address Line | 5150A SR 247
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City | POTTSVILLE
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State | AR
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Zip | 72858-6002
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Country | US
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Telephone | 479-567-5680
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Fax | 479-567-5679
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Authorized Official
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Title or Position | OWNER
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Name | SHANNAN SOUZA
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Credential | APRN-CNP
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Telephone | 479-495-0821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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