NPI | 1124697495 |
---|---|
Former Name | EMILY RAE GOFF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11010426) |
Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11010426) |
Enumeration Date | 2021-06-22 |
Last Update Date | 2023-01-10 |