| NPI | 1831557875 |
|---|---|
| Former Name | SHANNON LAVELLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 5770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3496) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 23019471) | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2023-12-17 |