| NPI | 1356065239 |
|---|---|
| Former Name | SHANNON E DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 95146801) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-03 |