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 | 2024-11-05 |