| NPI | 1790056711 |
|---|---|
| Former Name | SHANA RISSMILLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS11685) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO 2575) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2026-04-23 |