NPI | 1912634296 |
---|---|
Former Name | ALLY AJA SHRADER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704324614) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704324614) |
363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704324614) | |
Enumeration Date | 2022-08-05 |
Last Update Date | 2025-09-23 |