| NPI | 1538571575 |
|---|---|
| Former Name | SHANNON RENEE BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: AR A003719) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |