NPI | 1154902773 |
---|---|
Former Name | MARIA R SCHULT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209022986) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021010429) |
Enumeration Date | 2021-04-15 |
Last Update Date | 2021-04-15 |