| NPI | 1174928667 |
|---|---|
| Former Name | RETTA SUGARPEA TELO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN172923) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN172923) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2024-10-27 |