NPI | 1225095060 |
---|---|
Former Name | SHELLY M KILLMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KS 45319) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 139284) |
163W00000X Registered Nurse (Licence: KS 14-72612-121) | |
363L00000X Nurse Practitioner (Licence: MO 139284) | |
Enumeration Date | 2006-04-26 |
Last Update Date | 2019-11-26 |