NPI | 1215363650 |
---|---|
Former Name | MOLLY M ODUM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-105530) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-05530) |
Enumeration Date | 2013-09-17 |
Last Update Date | 2016-08-24 |