| NPI | 1396493789 |
|---|---|
| Former Name | SHANNON WILDER GERVAIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ 276686) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN205721) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-02-10 |