| NPI | 1194804815 |
|---|---|
| Former Name | NICHOLE A MACCONNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009050) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 334797) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2013-01-07 |