| NPI | 1386988392 |
|---|---|
| Former Name | SHANNON JANELLE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5005969) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 184446) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2018-07-29 |