| NPI | 1659031078 |
|---|---|
| Former Name | SHELBY E VAN DEN BERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 119989) |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2023-08-02 |