| NPI | 1508884917 |
|---|---|
| Former Name | SHELLY JOAN MYROM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 1378) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN R0848026) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-01-29 |