NPI | 1164634697 |
---|---|
Former Name | LAURA L JOLLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 8847) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0005165-NP) |
363LF0000X Nurse Practitioner, Family (Licence: OR 201403551NP-PP) | |
Enumeration Date | 2007-05-04 |
Last Update Date | 2024-03-21 |