| NPI | 1578997698 | 
|---|---|
| Former Name | ALLISON SHANNON | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5777)  | 
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 5777)  | 
| Enumeration Date | 2013-08-26 | 
| Last Update Date | 2024-05-23 |