| NPI | 1760813570 |
|---|---|
| Former Name | STEPHANIE LINNEA SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12562) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CDR 997338) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2020-01-06 |