NPI | 1033545272 |
---|---|
Former Name | LYDIA MICHELLE MAYES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 500816) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5008106) |
363LF0000X Nurse Practitioner, Family (Licence: PA SP012872) | |
Enumeration Date | 2013-09-19 |
Last Update Date | 2023-08-02 |