NPI | 1154393940 |
---|---|
Former Name | SHANNON ELIZABETH SHORT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101016653) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 260251) |
207Q00000X Family Medicine (Licence: CT 52347) | |
Enumeration Date | 2006-02-06 |
Last Update Date | 2025-06-25 |