| NPI | 1386167799 |
|---|---|
| Former Name | SHANNON D GRAHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 7787-33) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS 907042) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2025-01-13 |