| NPI | 1053849851 |
|---|---|
| Former Name | MARNIE BASTA COLLETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MT NUR-APRN-LIC-125902) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2017-05-24 |