NPI | 1225464043 |
---|---|
Former Name | LATOYA DIMITRA CHAMP |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5013479) |
Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NC 240383) |
Enumeration Date | 2013-09-25 |
Last Update Date | 2020-09-30 |