| NPI | 1023678620 |
|---|---|
| Former Name | SHANNON LYNN WOOD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0007101) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0007101) |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C0007101) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |