NPI | 1023654662 |
---|---|
Former Name | ANNA E SIMONICH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 9757) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 220513) |
363L00000X Nurse Practitioner (Licence: MN 10769) | |
363LF0000X Nurse Practitioner, Family (Licence: WI 9757-33) | |
Enumeration Date | 2019-11-19 |
Last Update Date | 2023-09-28 |