NPI | 1023654647 |
---|---|
Former Name | MICAELA RAE CAMPBELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015772) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11015772) |
163WE0003X Registered Nurse, Emergency (Licence: FL RN9469517) | |
Enumeration Date | 2019-11-19 |
Last Update Date | 2024-03-04 |