| NPI | 1194767152 |
|---|---|
| Former Name | SHAWNNA ANN WILLENBORG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2202002189) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-08 |