| NPI | 1053821678 |
|---|---|
| Former Name | MAURICIA CHAMOISE PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-126579) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-126579) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |