| NPI | 1487072864 |
|---|---|
| Former Name | SHANNON ROSE LOPEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MS A810578) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: TN 18577) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2022-01-27 |