NPI | 1770093155 |
---|---|
Former Name | SHANNON MARIE RUDESHEIM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 22686) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 22686) |
363LF0000X Nurse Practitioner, Family (Licence: TN 22686) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: TN 22686) | |
Enumeration Date | 2017-10-11 |
Last Update Date | 2022-03-25 |