NPI | 1982025680 |
---|---|
Former Name | SHANNON JO MCDONNELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C154146) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA C154146) |
363LA2100X Nurse Practitioner, Acute Care (Licence: IA C154146) | |
363LP0200X Nurse Practitioner, Pediatrics (Licence: MN R 217536-0) | |
Enumeration Date | 2013-12-23 |
Last Update Date | 2019-09-05 |