| NPI | 1407176480 |
|---|---|
| Former Name | SHANNON BETH MEAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO 990039) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3672) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2013-05-31 |