| NPI | 1134375280 |
|---|---|
| Former Name | SUSAN PROVORSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-46228-041) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2020-04-10 |