NPI | 1104246545 |
---|---|
Former Name | SHANNON RENEE WELLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME144400) |
Enumeration Date | 2014-04-24 |
Last Update Date | 2025-01-10 |