| NPI | 1417124538 |
|---|---|
| Former Name | SHANNON GABRIELLE BRADLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD60293423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60293423) |
| 207Q00000X Family Medicine (Licence: MN 51866) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2024-11-08 |