| NPI | 1922240589 |
|---|---|
| Former Name | SHANNON ELIZABETH WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-00474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA08533200) |
| Enumeration Date | 2009-03-29 |
| Last Update Date | 2018-04-25 |