| NPI | 1144325622 |
|---|---|
| Former Name | NICOLE AUTUMN SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME138382) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 324770) |
| 208000000X Pediatrics (Licence: TX Q0568) | |
| 208000000X Pediatrics (Licence: OK 24093) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-01-25 |