NPI | 1205828654 |
---|---|
Former Name | GLADYS BETH DURST |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 2145-33) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 102011) |
163W00000X Registered Nurse (Licence: WI 102011-030) | |
Enumeration Date | 2005-08-19 |
Last Update Date | 2025-09-10 |