NPI | 1043514193 |
---|---|
Former Name | CRYSTAL MARIE INGERSOLL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 720890) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 720890) |
Enumeration Date | 2011-01-04 |
Last Update Date | 2018-05-04 |