| NPI | 1811322027 |
|---|---|
| Former Name | SHANNON TAIT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209010332) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 10052937) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 14252956-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT APRN-280203) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 86865) | |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN5647-0) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2025049738) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP70066860) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2026-01-08 |