| NPI | 1124204565 |
|---|---|
| Former Name | KELLY MAVREEN GAUGHON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209.005610) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209-005610) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2021-11-24 |