| NPI | 1124522693 |
|---|---|
| Former Name | TERESA WHITAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.246350) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-11-29 |