| NPI | 1083159040 |
|---|---|
| Former Name | NICOLE AMANDA DEJEAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: LA AP09056) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN117994) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2016-12-30 |