| NPI | 1740511831 |
|---|---|
| Former Name | SHOSTY SUE HEYBLOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10742) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 10742) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2023-05-31 |