| NPI | 1457654204 |
|---|---|
| Former Name | SHANNON DANIELLE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02702) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2020-10-26 |