NPI | 1083968440 |
---|---|
Former Name | SHANNON CASTELLI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 20084) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP012439) |
Enumeration Date | 2012-11-06 |
Last Update Date | 2016-03-28 |