| NPI | 1205104353 |
|---|---|
| Former Name | PRISCILLA ANTONETTE MAHADEVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OH 2017025995) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: UT 6482098-4405) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2019-10-17 |