Clark, Shannon Jackie
Clark, Shannon Jackie is an sole proprietor health care provider with primary practice located at 10750 S Knoll Crest Ln , Tucson AZ 85706-9052. She recently has only one registered license in Other Service Providers / Contractor, which is considered as her primary health care specialty. Clark, Shannon Jackie can be contacted via phone (520) 574-2911.Contact Information
Primary practice address
10750 S Knoll Crest Ln
Tucson AZ 85706-9052
Phone: (520) 574-2911
Fax: (520) 750-0056
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Contractor | 171W00000X | 11816 | Arizona |
Profile Details
| NPI number | 1700940855 |
|---|---|
| LBN Legal business name | Clark, Shannon Jackie |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 21st, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700940855 | NPPES |
| Arizona | MEDICAID | 162753 |
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