| NPI | 1760946669 |
|---|---|
| Former Name | SHANNON ROOT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020023147) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2022-08-17 |