| NPI | 1447702667 |
|---|---|
| Former Name | SHANNON MARIE DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA 2016015157) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2024-02-22 |