NPI | 1992756860 |
---|---|
Former Name | SHANNON K KELLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036116996) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD601430689) |
208M00000X Hospitalist (Licence: WA MD60143689) | |
Enumeration Date | 2006-05-15 |
Last Update Date | 2024-12-13 |