| NPI | 1023422805 |
|---|---|
| Former Name | DJANINN MAE SHANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11613) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2023-02-22 |