NPI | 1003530668 |
---|---|
Former Name | REBECCA FAITH SANDSTROM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MT NUR-APRN-LIC-198093) |
Enumeration Date | 2022-09-28 |
Last Update Date | 2022-09-28 |