| Doctor Name: | DR. SHANNON RENEE BLACKMER |
| NPI Number: | 1346314739 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M. D. |
| License Number: | A97553 |
| Business Practice Address: | 1340 C V Towway Bldg Lf-59 Hsc-28 Medical Norfolk, VA - 235112520 |
| Business Phone Number: | 7579538868 |
| Business Fax Number: | |
| Mailing Address: | 1340 C V Towway Bldg Lf-59, Hsc-28 Medical NORFOLK |
| State: | VA |
| Postal Code: | 235112520 |
| Phone Number: | 7579538868 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2006 |
| NPI Last Update Date: | 04/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A97553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |