Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 154005 | MO |
NPI | 1265652432 |
---|---|
Provider Name | Tonya Sue Shearer |
First Address | O Fallon, IL 62269-2241 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 12/11/2020 |