| NPI | 1205805223 |
|---|---|
| Former Name | PAULA BROCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent (Licence: IA 053214) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IA Z053214) |
| 364SP0807X Clinical Nurse Specialist Psychiatric/Mental Health, Child & Adolescent (Licence: IA Z053214) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |