NPI | 1205187432 |
---|---|
Former Name | JULIE RENEE HOLLOWAY OR DEPETRO-KEYES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 14266) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 14266) |
363LF0000X Nurse Practitioner, Family (Licence: CA 468057 RN/ 14266 FNP) | |
Enumeration Date | 2012-09-27 |
Last Update Date | 2018-07-31 |