| NPI | 1174304158 |
|---|---|
| Former Name | CRISTTEN MAE PENSE MCKIBBEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2023039401) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2023039401) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2024-01-31 |