NPI | 1831579853 |
---|---|
Former Name | SHANDA SUZANNE THOMAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11025689) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AL 1-134326) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: GA 208000000X) | |
Enumeration Date | 2015-06-04 |
Last Update Date | 2023-09-14 |