| NPI | 1215480462 |
|---|---|
| Former Name | SHANNON GROSS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2016-07-24 |
| Last Update Date | 2023-06-26 |