| NPI | 1396209326 |
|---|---|
| Former Name | STEPHANIE NICOLE SHANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5011367) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5011367) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2023-06-07 |