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NPI Code Detail

MEDICARE: DR. SHANNON MARIE TREEN N.M.D.

MEDICARE: DR. SHANNON MARIE TREEN N.M.D.
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
1175F00000XNaturopath11-1235AZ

General Provider Information

NPI Number : 1306138839
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON MARIE TREEN N.M.D.
Provider Business Mailing Address
First Line : 6445 S MAPLE AVE APT 2021
Second Line :
City : TEMPE
State : AZ
Zip : 85283-3639
Country : US
Telephone Number : 985-710-0765
Fax Number :
Provider Business Practice Location Address
First Line : 4140 E BASELINE RD STE 110
Second Line :
City : MESA
State : AZ
Zip : 85206-4413
Country : US
Telephone Number : 480-539-0777
Fax Number : 480-539-6054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2011
Last Update Date : 05/03/2011

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