| NPI | 1609561604 |
|---|---|
| Former Name | GRACE EILEEN SHEA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 100723-851) |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2024-06-12 |