| NPI | 1053631523 |
|---|---|
| Former Name | SUSAN SHADLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA8941) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054377) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2024-10-28 |