NPI | 1134347347 |
---|---|
Former Name | CAROL ANN REYBURN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VA 0101265405) |
Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MO 2007006297) |
Enumeration Date | 2007-04-23 |
Last Update Date | 2021-11-02 |