| NPI | 1619227667 |
|---|---|
| Former Name | NICOLE SHUNAMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner Women's Health (Licence: MA 2311801) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: NY 382294) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2022-02-09 |