| NPI | 1124556584 |
|---|---|
| Former Name | MISTY DANELLE POLSTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 21023) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: SC 21023) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-03-26 |