NPI | 1144690355 |
---|---|
Former Name | KRISTA MARIE MACK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015425) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN611100) |
Enumeration Date | 2015-09-30 |
Last Update Date | 2015-10-19 |