NPI | 1225491152 |
---|---|
Former Name | SHANNON LOUISE DONOVAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 66655) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 267966) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 66655) | |
Enumeration Date | 2016-03-29 |
Last Update Date | 2021-09-03 |