| NPI | 1164633111 |
|---|---|
| Former Name | PAMELA LATARSHA BLUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2008022566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008022566) |
| 207Q00000X Family Medicine (Licence: MO 2005021689) | |
| 207Q00000X Family Medicine (Licence: IL 036.154328) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2024-09-10 |