| NPI | 1124008115 |
|---|---|
| Former Name | BRANDY GEAN MOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024176940) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2019-02-26 |