NPI | 1104600394 |
---|---|
Former Name | CAITLAN ANN RODGERS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 11665) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN F08230671) |
Enumeration Date | 2023-08-21 |
Last Update Date | 2024-10-02 |