| NPI | 1114311354 |
|---|---|
| Former Name | STEPHANIE ELISE LAURENCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6016) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2020-12-04 |