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 |