| NPI | 1285290536 |
|---|---|
| Former Name | ANNISSA SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704316591) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704316591) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-08-24 |