| NPI | 1689246670 |
|---|---|
| Former Name | SHANNON MARIE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 13341645-8900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 13341645-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024185946) | |
| 163WG0000X Registered Nurse, General Practice (Licence: VA 0001160108) | |
| 376J00000X Homemaker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-11 |
| Last Update Date | 2023-04-27 |