NPI | 1356502389 |
---|---|
Former Name | SHANNON L HANSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 53315) |
Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN 53315) |
2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC LL30894) | |
Enumeration Date | 2008-06-23 |
Last Update Date | 2025-09-17 |