| NPI | 1871532465 |
|---|---|
| Former Name | SHANNON LEIGH FOWLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M1468) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: TX M1468) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: TX M1468) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-08-15 |