| NPI | 1386078418 |
|---|---|
| Former Name | SHELLY D THEOBALD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 38491) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60390210) |
| 207Q00000X Family Medicine (Licence: ID M-15041) | |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2021-07-23 |