| NPI | 1144377631 |
|---|---|
| Former Name | SHELLY LYNN DIECKHOFF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 4446-33) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: WI 144314-030) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2015-11-04 |