| NPI | 1912990540 |
|---|---|
| Former Name | SHANNA JOY DAVENPORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 10458) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN10458) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2015-03-11 |