NPI | 1114386752 |
---|---|
Former Name | LAURA MARIE DEBO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.013658) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.377186) |
Enumeration Date | 2016-02-10 |
Last Update Date | 2019-09-12 |