NPI | 1114233707 |
---|---|
Former Name | KRISTEN MICHELLE BURGDORFF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 15110) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 143876) |
Enumeration Date | 2010-08-20 |
Last Update Date | 2020-12-09 |