| NPI | 1598229478 |
|---|---|
| Former Name | SHAINA MARIE BLACKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WI 9036-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 177820-30) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2019-02-05 |