| NPI | 1295770220 |
|---|---|
| Former Name | SHANNON A PRUITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-096078) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN132591) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2018-04-24 |