NPI | 1124456736 |
---|---|
Former Name | CARLY GAGNON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209019723) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2014001970) |
Enumeration Date | 2013-10-16 |
Last Update Date | 2024-09-18 |