| NPI | 1932695178 |
|---|---|
| Former Name | SHAE LEANN FREDRICKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2429090) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MN 26681) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2018-07-10 |