| NPI | 1568842482 |
|---|---|
| Former Name | SHANNON FOGG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP7863) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ AP7863) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-04-23 |