| NPI | 1548300585 |
|---|---|
| Former Name | SHANNA M MOEDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 178095) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: AK 193) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2021-09-07 |