| NPI | 1134102965 |
|---|---|
| Former Name | TAMARA SUE RIVENBURGH-CASILLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP0528) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ ap0528) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2016-09-01 |