| NPI | 1598118358 |
|---|---|
| Former Name | SHANNON MARY VAN MARTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 20357) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 0001762) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2024-08-28 |