| NPI | 1225617103 |
|---|---|
| Former Name | SHANNON VANDER BERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2021-12-29 |