NPI | 1134475759 |
---|---|
Former Name | ANGELA D MCMAHON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277000127) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 277000127) |
363LF0000X Nurse Practitioner, Family (Licence: IL 209009641) | |
363LF0000X Nurse Practitioner, Family (Licence: IL 277000127) | |
Enumeration Date | 2012-08-01 |
Last Update Date | 2023-04-04 |