| NPI | 1891715132 |
|---|---|
| Former Name | SHANNON ELISABETH ANDERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002320) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-002320) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2009-01-23 |