| NPI | 1043987514 |
|---|---|
| Former Name | DESIREE NOELLE NICHOLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 1159163) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61211144) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP61211144) | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2024-05-29 |