| NPI | 1710560628 |
|---|---|
| Former Name | SHELBY ELIZABETH BACON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2021015301) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2016021485) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2024-11-29 |