NPI | 1134764608 |
---|---|
Former Name | SHANNON MARIE HIGGINBOTHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-113275) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 113275) |
363LF0000X Nurse Practitioner, Family (Licence: TN 32107) | |
Enumeration Date | 2019-11-08 |
Last Update Date | 2023-08-16 |