NPI | 1134748080 |
---|---|
Former Name | SHANNON RASMUSSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA200776) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 59765) |
363AM0700X Physician Assistant, Medical (Licence: UT 7680341-1206) | |
Enumeration Date | 2020-04-10 |
Last Update Date | 2021-09-23 |