| NPI | 1891181459 |
|---|---|
| Former Name | SHANNON RAE MUNDINGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 176886) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WI 176886) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-04-15 |