| NPI | 1700397213 |
|---|---|
| Former Name | SHELBY LYNN PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA059461) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA004315) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2024-09-24 |