NPI | 1558344812 |
---|---|
Former Name | KELLI R. SHELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 1735) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 1735) |
363AS0400X Physician Assistant, Surgical (Licence: WY 481) | |
Enumeration Date | 2005-11-21 |
Last Update Date | 2018-01-02 |