NPI | 1114818762 |
---|---|
Former Name | RYLAN SAVANAH GREEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95036094) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95036094) |
Enumeration Date | 2025-07-11 |
Last Update Date | 2025-09-15 |