NPI | 1164700084 |
---|---|
Former Name | MELISSA VIRGINIA MOORE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 21217) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 671197) |
Enumeration Date | 2011-07-26 |
Last Update Date | 2016-03-02 |