Provider Demographics
NPI:1144414277
Name:BESLER, SHANNON
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:BESLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:SELIGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86337-0995
Mailing Address - Country:US
Mailing Address - Phone:928-925-0942
Mailing Address - Fax:
Practice Address - Street 1:134 BESLER WAY
Practice Address - Street 2:
Practice Address - City:JUNIPER MOUNTAIN RANCH
Practice Address - State:AZ
Practice Address - Zip Code:86337
Practice Address - Country:US
Practice Address - Phone:928-925-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ308392385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child