NPI | 1295324838 |
---|---|
Former Name | SHANNON STARUK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA65562) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
363A00000X Physician Assistant (Licence: MA PA8729) | |
Enumeration Date | 2021-01-17 |
Last Update Date | 2024-12-11 |