Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1447612205 |
---|---|
Provider Name | Shannon Ovwigho |
First Address | Gainesville, FL 32601-4137 |
Second Address | Gainesville, FL 32601-4137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 22/03/2016 |