| NPI | 1033777826 |
|---|---|
| Former Name | JOLLY AUGUSTINE POTTAMMEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: GA RN190105) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: GA RN190105) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |