| NPI | 1215518014 |
|---|---|
| Former Name | MACY FAYE SHIVELY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 00000000x) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2021-04-14 |