NPI | 1104496538 |
---|---|
Former Name | HEIDI KRISTINE NELSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0011441) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003785) |
Enumeration Date | 2021-06-28 |
Last Update Date | 2022-01-24 |