| NPI | 1073375218 |
|---|---|
| Former Name | KATHLEEN LUCILLE THEISEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: IN 71015420A) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: IN 28224547C) |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2024-07-11 |