Provider Demographics
NPI:1235784539
Name:SHANNON, TAMARA S (CMA AAMA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:S
Last Name:SHANNON
Suffix:
Gender:F
Credentials:CMA AAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N 6800 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-8605
Mailing Address - Country:US
Mailing Address - Phone:801-389-1031
Mailing Address - Fax:
Practice Address - Street 1:9240 N 6800 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-8605
Practice Address - Country:US
Practice Address - Phone:801-389-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider