| NPI | 1366107526 |
|---|---|
| Former Name | KATELYN NICOLE SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: MO 2021040572) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021040572) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2023-12-14 |