| NPI | 1972856706 |
|---|---|
| Former Name | SHANNON TARA WHITTEMORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5009248) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 005158) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2019-05-08 |