| NPI | 1669665964 |
|---|---|
| Former Name | SHANNON LARIE HUMPHREY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP115188) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 653277) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2015-08-03 |