| NPI | 1033508635 |
|---|---|
| Former Name | SHUNTELLE WHITESIDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RN138878) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP7573) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2020-06-19 |