NPI | 1114319746 |
---|---|
Former Name | CONNIE MARIE ST. LAURENT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: UT 12218275-4405) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MT 217324) |
363LA2200X Nurse Practitioner, Adult Health (Licence: OH 021522) | |
Enumeration Date | 2015-02-18 |
Last Update Date | 2024-10-09 |