| NPI | 1013364272 |
|---|---|
| Former Name | CHARLA REISDORPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2022012666) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2022012666) |
| 363L00000X Nurse Practitioner (Licence: KS 77143) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2023-02-16 |