| NPI | 1811660822 |
|---|---|
| Former Name | SHANDA RETTA MAE GEARHART |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 28260) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 9965) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2024-12-03 |