| NPI | 1942754015 |
|---|---|
| Former Name | SHELLY LYNN PANGBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402033) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 402033) |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2024-02-16 |