| NPI | 1013535301 |
|---|---|
| Former Name | HALEY SUSAN VANDERVATE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209028447) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2024-02-01 |