Provider Demographics
NPI:1417681230
Name:CREAMER, SHANNON MARIE (LCCE)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:CREAMER
Suffix:
Gender:F
Credentials:LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TRIMBLE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3819
Mailing Address - Country:US
Mailing Address - Phone:304-995-8104
Mailing Address - Fax:
Practice Address - Street 1:105 TRIMBLE AVE APT 1
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3819
Practice Address - Country:US
Practice Address - Phone:304-995-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty