| NPI | 1104033018 |
|---|---|
| Former Name | SHANON STAR HEATON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA P20292) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001546) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-02-16 |