| 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 |