NPI | 1518716828 |
---|---|
Former Name | SHANNON BETH CUMMINGS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209021511) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 306080) |
Enumeration Date | 2024-05-17 |
Last Update Date | 2024-05-17 |