| NPI | 1376003673 |
|---|---|
| Former Name | SHANNON ELIZABETH RENNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2019026756) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 2105) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2021-03-29 |