| NPI | 1871603902 | 
|---|---|
| Former Name | SHANNON C MILLER | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-2265) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA61086741) | 
| 363AM0700X Physician Assistant, Medical (Licence: PA MA058013) | |
| Enumeration Date | 2006-08-30 | 
| Last Update Date | 2025-07-25 |