| NPI | 1760657498 |
|---|---|
| Former Name | SHANDA RAE LAWSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 70139-20) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2020-12-22 |