| NPI | 1144224932 |
|---|---|
| Former Name | SHANNON CALLAWAY VICKERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NM PA2022-0043) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD Coo2607) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2024-04-03 |