NPI | 1205263589 |
---|---|
Former Name | MEGAN LYNN PETERMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209016161) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209016161) |
363LF0000X Nurse Practitioner, Family (Licence: MO 200816179) | |
Enumeration Date | 2013-10-02 |
Last Update Date | 2022-01-17 |