NPI | 1194704403 |
---|---|
Former Name | SHAWN RENEE LUCK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3003115) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3003115) |
Enumeration Date | 2006-01-13 |
Last Update Date | 2020-10-26 |