| 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 |