| NPI | 1215519814 |
|---|---|
| Former Name | DESA MARIAH ELDRIDGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 113657) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 64709) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2021-07-07 |