| NPI | 1063032704 |
|---|---|
| Former Name | DESTINEE TERRY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: AL 1-169115) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-169115) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-169115) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2023-12-06 |