| NPI | 1376978692 |
|---|---|
| Former Name | SHANNON NICOLE SCRUGGS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001923A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002405) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2022-02-03 |