| NPI | 1255785515 |
|---|---|
| Former Name | SHANNON RODRIGUEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0992329) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3017791) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 10256) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 10256) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-08-14 |