| NPI | 1063130995 |
|---|---|
| Former Name | SHAWN ELLEN KENNEDY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11021419) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 2022029844) |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-08-17 |