| NPI | 1306152558 |
|---|---|
| Former Name | SHAUNA J MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11029426) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006595) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 23235) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2023-12-29 |