| NPI | 1265886071 |
|---|---|
| Former Name | KELLY SHANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004710) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 724598) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2024-12-11 |