| NPI | 1023523412 |
|---|---|
| Former Name | KATELIN JUDITH PRUISMANN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A136840) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA A136840) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2022-10-05 |