| NPI | 1104032218 |
|---|---|
| Former Name | LAURA RENAE PHELPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN247115) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 004365) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 701633) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-03-06 |