NPI | 1114400397 |
---|---|
Former Name | CHERISE DECORAH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 13468) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WI 195999) |
163WC0200X Registered Nurse, Critical Care Medicine (Licence: MN 2467240) | |
Enumeration Date | 2018-09-13 |
Last Update Date | 2023-09-11 |