| NPI | 1073120325 |
|---|---|
| Former Name | SALLY ROSE MCSHANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71010369A) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: IN 71010369A) |
| 163W00000X Registered Nurse (Licence: IN 28196065A) | |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-12-17 |