| NPI | 1811459837 |
|---|---|
| Former Name | KELSEY IDINA SHIDELER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 289565) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60962155) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-04-14 |