NPI | 1407159924 |
---|---|
Former Name | SHAWNA L PERSONS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105812) |
Additional Taxonomies | 207N00000X Dermatology (Licence: FL PA9105812) |
Enumeration Date | 2010-12-07 |
Last Update Date | 2018-11-08 |