| NPI | 1841673753 |
|---|---|
| Former Name | SHANNON WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: KY 1111715) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: KY 1111715) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2019-05-29 |