| NPI | 1225583453 |
|---|---|
| Former Name | KRYSTINE MCCLELLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209014722) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A129550) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2021-11-15 |