| NPI | 1407143092 |
|---|---|
| Former Name | SHELLY ANN DEWAYNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 200441350RN) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2018-03-17 |