| NPI | 1912065855 |
|---|---|
| Former Name | SHANNON M. JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 20339-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 50339-20) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-03-18 |