| NPI | 1437349172 |
|---|---|
| Former Name | SHANETHA GOSS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704232658) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704232658) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2019-09-26 |