| NPI | 1619189859 |
|---|---|
| Former Name | LACIE SHANKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036119502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-050112) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-02-12 |