| NPI | 1023161742 |
|---|---|
| Former Name | SHANNON TRACEY MCCLINTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052968) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-291) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-10-15 |