Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | SP020051 | PA |
NPI | 1043877988 |
---|---|
Provider Name | Mrs. Shannon Westbrook |
First Address | Broomall, PA 19008-3728 |
Second Address | Plymouth Meeting, PA 19462-2324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/05/2019 |